# RE VIVIFY MD HEALTH AND WELLNESS CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023949617
- **Authorized official:** NIJAH BURRIS MD (FAMILY AND AESTHETIC MEDICINE)
- **Authorized official phone:** (678) 850-3509

## Contact information

- **Practice address:** 898 OAK ST SW, ATLANTA, GA 30310-1959
- **Practice address phone:** (678) 850-3509
- **Practice address fax:** (678) 850-3509
- **Mailing address:** 898 OAK ST SW UNIT 3425, ATLANTA, GA 30310-1974
- **Mailing address phone:** (678) 850-3509
- **Mailing address fax:** (678) 850-3509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207QA0505X | Adult Medicine Physician | — | NULL | — |
| 207QA0505X | Adult Medicine Physician | — | — | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 207QP0002X | Physician Nutrition Specialist (Family Medicine) | — | NULL | — |
| 207QP0002X | Physician Nutrition Specialist (Family Medicine) | — | — | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | — | — | — |

## Other

- **Enumeration date:** 05/25/2026
- **Last updated:** 05/25/2026