Organization
REVIVED MEDICAL COMMUNITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVANDA MARTIN APRN (CEO,OWNER)
(843) 799-2649
Entity
Organization
Contact information
Practice address
2724 W PALMETTO ST STE 5, FLORENCE, SC 29501-4909
(843) 799-2649
Mailing address
2724 W PALMETTO ST STE 5, FLORENCE, SC 29501-4909
(843) 799-2649
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
12/11/2024
Last updated
01/06/2025
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