Organization
REVIVE PALMETTO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JARROD ALEXANDER LITTLE MD (OWNER)
(843) 575-3308
Entity
Organization
Contact information
Practice address
206 BLUFFTON RD FL 2, BLUFFTON, SC 29910-6213
(843) 575-3308
(502) 324-4035
Mailing address
112 MAINLAND LAKES DR, BLUFFTON, SC 29910-4562
(843) 575-3308
(502) 324-4035
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023166139
INDIVIDUAL NPI
—
01
—
41316
KENTUCKY MEDICAL LICENSE
KY
01
—
MD90614
SOUTH CAROLINA MEDICAL LICENSE
SC
Enumeration date
03/05/2024
Last updated
03/05/2024
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