| Organization Name: | RIVERSTONEMD PC |
| NPI Number: | 1285661595 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PEGGY TRIGG (CREDENTIALING MANAGER) |
| Mailing Address: | 101 Riverstone Vis Suite 205 Blue Ridge |
| State: | GA US |
| Postal Code: | 305136648 |
| Phone Number: | 7062584100 |
| Fax Number: | 7066323585 |
| NPI Enumeration Date: | 06/26/2006 |
| NPI Last Update Date: | 03/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 032826 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |