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General NPI Number Information
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NPI Number | 1902378581
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Entity Type | Organization
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Legal Business Name | REVITAL HEALTH AND WELLNESS CLINICS PLLC
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Dates
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Enumeration Date | 12/20/2018
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 695 PRESIDENT PL STE 200
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City | SMYRNA
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State | TN
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Zip | 37167-5681
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Country | US
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Telephone | 615-768-5552
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Fax | 615-768-5583
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Provider Business Mailing Address
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Address Line | 695 PRESIDENT PL STE 200
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City | SMYRNA
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State | TN
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Zip | 37167-5681
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Country | US
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Telephone | 615-768-5552
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Fax | 615-768-5583
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Authorized Official
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Title or Position | OWNER/NP
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Name | MR. JOSEPH BRANDON SWEAT
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Credential | NP
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Telephone | 615-768-5552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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