Organization
REVIVE WOUND CARE GA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL DAVIS (MANAGER)
(951) 760-6216
Entity
Organization
Contact information
Practice address
980 ROWLAND ST, STE 5140 #1111, CLARKSTON, GA 30021
(951) 760-6216
Mailing address
980 ROWLAND ST, STE 5140 #1111, CLARKSTON, GA 30021
(951) 760-6216
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
251E00000X
Home Health Agency
—
—
Other
Enumeration date
10/24/2024
Last updated
10/24/2024
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