# REVIVAL MEDICAL GROUP

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

## Provider details

- **NPI number:** 1184381469
- **Authorized official:** AMY NEALEY (DIRECTOR)
- **Authorized official phone:** (910) 679-4312

## Contact information

- **Practice address:** 1508 MILITARY CUTOFF RD STE 203, WILMINGTON, NC 28403-5730
- **Practice address phone:** (910) 679-4312
- **Mailing address:** 1508 MILITARY CUTOFF RD STE 203, WILMINGTON, NC 28403-5730
- **Mailing address phone:** (910) 679-4312

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | NULL | Yes |
| 2083P0901X | Public Health & General Preventive Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/22/2021
- **Last updated:** 11/22/2021