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Revive Hydration And Functional Health Llc
Medical Specialty Clinic/Center in Douglas, Georgia
NPI 1558128314

Revive Hydration And Functional Health Llc is a Medical Specialty Clinic/Center based in Douglas, GA and is specialized in Medical Specialty. Revive Hydration And Functional Health Llc practices in Douglas, GA. The NPI Number for Revive Hydration And Functional Health Llc is 1558128314 and holds a License No. (Georgia).

The current practice location address for Revive Hydration And Functional Health Llc is 1150 Ward Street Ext W Ste B1, Douglas, GA and can be reached out via phone at 912-720-5450 and via fax at 866-611-2696. You can also correspond with Revive Hydration And Functional Health Llc through the mailing address at 1150 WARD STREET EXT W STE B1, DOUGLAS, GA - 31533-1913 (mailing address contact number: 912-720-5450).

Location: 1150 Ward Street Ext W Ste B1, Douglas, GA, 31533-1913
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1558128314
Provider Name
Revive Hydration And Functional Health Llc
Credential
Provider Entity Type
Organization
Address
1150 Ward Street Ext W Ste B1, Douglas, GA, 31533-1913
Phone Number
912-720-5450
Fax Number
866-611-2696
Provider Enumeration Date
02/28/2024
Last Update Date
04/14/2024
institution
Provider Business Practice Location Address Details
Address
1150 Ward Street Ext W Ste B1
City
Douglas
State
Georgia
Zip
31533-1913
Phone Number
912-720-5450
Fax Number
866-611-2696
person
Provider Business Mailing Address Details
Address
1150 Ward Street Ext W Ste B1
City
Douglas
State
Georgia
Zip
31533-1913
Phone Number
912-720-5450
Fax Number
866-611-2696
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Infusion Therapy
Taxonomy
261QI0500X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
()
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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