Organization
REVIVE HYDRATION AND FUNCTIONAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOBBY J GUESS JR. FNP-C (OWNER)
(912) 720-5450
Entity
Organization
Contact information
Practice address
1150 WARD STREET EXT W STE B1, DOUGLAS, GA 31533-1913
(912) 720-5450
(866) 611-2696
Mailing address
1150 WARD STREET EXT W STE B1, DOUGLAS, GA 31533-1913
(912) 720-5450
(866) 611-2696
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
02/28/2024
Last updated
02/28/2024
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