| Revitalife, Inc | |
|
102 Mary Alice Park Rd Ste 402 Cumming GA 30040-2692 | |
| (770) 744-1409 | |
| Not Available |
| Full Name | Revitalife, Inc |
|---|---|
| Speciality | Internal Medicine - Obesity Medicine |
| Location | 102 Mary Alice Park Rd Ste 402, Cumming, Georgia |
| Authorized Official Name and Position | Davia Ward (CEO) |
| Authorized Official Contact | 7707441409 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revitalife, Inc 102 Mary Alice Park Rd Ste 402 Cumming GA 30040-2692 Ph: (770) 744-1409 | Revitalife, Inc 102 Mary Alice Park Rd Ste 402 Cumming GA 30040-2692 Ph: (770) 744-1409 |
| NPI Number | 1104504406 |
|---|---|
| Provider Enumeration Date | 07/06/2023 |
| Last Update Date | 07/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104504406 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RB0002X | Internal Medicine - Obesity Medicine | (* (Not Available)) | Primary |
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