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Organization

REVIVAL WOUND SPECIALISTS LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAT LE NP (OWNER)
(470) 979-7018
Entity
Organization

Contact information

Practice address
302 BERMUDA RDG, PERRY, GA 31069-8756
(470) 979-7018
Mailing address
302 BERMUDA RDG, PERRY, GA 31069-8756

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary

Other

Enumeration date
01/09/2026
Last updated
01/09/2026
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