Organization
REVIVE MD
Active
Other names
BlueSky MD
Organization subpart
No
Provider details
NPI number
Authorized official
DAPHNE BAKER LODGE RN (PRESIDENT)
(615) 690-6600
Entity
Organization
Contact information
Practice address
1804 WILLIAMSON CT, SUITE 107, BRENTWOOD, TN 37027-8170
(615) 690-6600
(615) 690-6604
Mailing address
1804 WILLIAMSON CT, SUITE 107, BRENTWOOD, TN 37027-8170
(615) 690-6600
(615) 690-6604
Taxonomy
Speciality
Code
Description
License number
State
207VB0002X
Obesity Medicine (Obstetrics & Gynecology) Physician
Primary
26575
TN
Other
Enumeration date
06/16/2010
Last updated
06/16/2010
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