MEDICARE: REVIVE HEALTHCARE SOLUTIONS 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1316719248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE HEALTHCARE SOLUTIONS LLC

Provider Business Mailing Address
First Line	:	100 GRACE HOPPER LN STE 3763
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-0009
Country	:	US
Telephone Number	:	877-777-9740
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 GRACE HOPPER LN STE 3763
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-0009
Country	:	US
Telephone Number	:	877-777-9740
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TANGELIA TOWNSEND
Credential	:
Telephone Number	:	877-777-9740

Provider Enumeration Date	:	10/24/2023
Last Update Date	:	10/24/2023

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Directions to “REVIVE HEALTHCARE SOLUTIONS LLC ” Practice Location

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