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NPI Code Detail

MEDICARE: REVORA HEALTH LLC

MEDICARE: REVORA HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1750238804
Entity Type Code : Organization
Provider Name (Legal Business Name) : REVORA HEALTH LLC
Provider Business Mailing Address
First Line : 5555 GLENRIDGE CONNECTOR STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30342-4815
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5555 GLENRIDGE CONNECTOR STE 200
Second Line : OFFICE 17TH
City : ATLANTA
State : GA
Zip : 30342-4815
Country : US
Telephone Number : 470-357-3971
Fax Number :
Authorized Official
Title or Position : OWNER
Name : HASSAN JAVAID
Credential :
Telephone Number : 470-357-3971
Provider Enumeration Date : 03/16/2026
Last Update Date : 06/08/2026

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