Organization
REVIVAL TRANS
Active
Organization
REVIVAL TRANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN DIXON HATTAWAY II (OWNER)
(615) 598-6255
Entity
Organization
Contact information
Practice address
3401 COUNTRY HILL RD, ANTIOCH, TN 37013-1017
(615) 598-6255
Mailing address
3401 COUNTRY HILL RD, ANTIOCH, TN 37013-1017
(615) 598-6255
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
190683
TN
Other
Enumeration date
03/02/2016
Last updated
09/06/2023
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