Revive Family Medical Clinic, LLC
NPI #1902577554 in Columbus, Mississippi
Provider Information
- NPI Number
- 1902577554
- Entity Type
- Organization
- Organization Name
- Revive Family Medical Clinic, LLC
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Sep 23, 2021
- Last Updated
- Nov 18, 2021
Practice Location
- Address
- 3549 BLUECUTT RD
- City
- Columbus
- State
- Mississippi
- ZIP Code
- 39705-1324
- Phone
- (662) 386-1541
Authorized Official
- Name
- MR. MICAH ALEXANDER GRANT, FNP
- Title
- NURSE PRACTITIONER
- Phone
- (662) 570-4174
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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