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Organization
REVIVAL MEDICAL GROUP
Active
Organization
REVIVAL MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY NEALEY (DIRECTOR)
(910) 679-4312
Entity
Organization
Contact information
Practice address
1508 MILITARY CUTOFF RD STE 203, WILMINGTON, NC 28403-5730
(910) 679-4312
Mailing address
1508 MILITARY CUTOFF RD STE 203, WILMINGTON, NC 28403-5730
(910) 679-4312
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
NULL
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
—
—
Other
Enumeration date
11/22/2021
Last updated
11/22/2021
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