Healthcare Provider Details

I. General information

NPI: 1265346621
Provider Name (Legal Business Name): REVIVE WELLNESS CLINIC OF OXFORD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OFFICE PARK DR STE 100
OXFORD MS
38655-3597
US

IV. Provider business mailing address

1200 OFFICE PARK DR STE 100
OXFORD MS
38655-3597
US

V. Phone/Fax

Practice location:
  • Phone: 662-801-5795
  • Fax:
Mailing address:
  • Phone: 662-801-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JOSHUA GRANT GRIFFIN
Title or Position: OWNER
Credential: MD
Phone: 662-801-5795