# REVIVE HYDRATION AND FUNCTIONAL HEALTH LLC

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

## Provider details

- **NPI number:** 1558128314
- **Authorized official:** BOBBY J GUESS JR. FNP-C (OWNER)
- **Authorized official phone:** (912) 720-5450

## Contact information

- **Practice address:** 1150 WARD STREET EXT W STE B1, DOUGLAS, GA 31533-1913
- **Practice address phone:** (912) 720-5450
- **Practice address fax:** (866) 611-2696
- **Mailing address:** 1150 WARD STREET EXT W STE B1, DOUGLAS, GA 31533-1913
- **Mailing address phone:** (912) 720-5450
- **Mailing address fax:** (866) 611-2696

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QI0500X | Infusion Therapy Clinic/Center | — | NULL | — |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/28/2024
- **Last updated:** 02/28/2024