Provider Demographics
NPI:1730572512
Name:RIVAS, MARIE SCARLETTE MUPADA (CNP)
Entity type:Individual
Prefix:
First Name:MARIE SCARLETTE
Middle Name:MUPADA
Last Name:RIVAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARIE SCARLETTE
Other - Middle Name:A
Other - Last Name:MUPADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:993 JOHNSON FERY RD
Mailing Address - Street 2:BLDG C, STE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-780-7860
Mailing Address - Fax:404-851-8673
Practice Address - Street 1:993 JOHNSON FERY RD
Practice Address - Street 2:BLDG C, STE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-780-7860
Practice Address - Fax:404-851-8673
Is Sole Proprietor?:No
Enumeration Date:2015-03-18
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220801363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003174611CMedicaid
GA003174611AMedicaid
GA003174611DMedicaid
GA003174611CMedicaid