Provider Demographics
NPI:1437871944
Name:RIVERA, ELEXUS
Entity type:Individual
Prefix:
First Name:ELEXUS
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELEXUS
Other - Middle Name:
Other - Last Name:SPRADLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:212 ABNER RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:GA
Mailing Address - Zip Code:30217
Mailing Address - Country:US
Mailing Address - Phone:762-323-8774
Mailing Address - Fax:
Practice Address - Street 1:2700 HIGHWAY 34 E STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2315
Practice Address - Country:US
Practice Address - Phone:470-394-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician