Organization
REVIVAL PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB SCOTT (OWNER)
(256) 431-6469
Entity
Organization
Contact information
Practice address
15884 E LIMESTONE RD, ATHENS, AL 35613-7522
(256) 431-6469
Mailing address
15884 E LIMESTONE RD, ATHENS, AL 35613-7522
(256) 431-6469
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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