Revive RX

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

REVIVE RX

Practice address

1252 Todiway CT
Jonesboro, GA 30238-6546

Phone

(770) 946-6976

NPI assigned

Oct 16, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Krystal Dublin

Title

Ceo

Phone

(770) 946-6976

Specialties & licenses 1

Addresses

Other names 1

• N/A Other name

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1104608009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 RAINBOW WAY UNIT 257",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302143994",
            "telephone_number": "770-946-6976",
            "fax_number": "972-777-5274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1252 TODIWAY CT",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302386546",
            "telephone_number": "770-946-6976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE RX",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-16",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "DUBLIN",
        "authorized_official_first_name": "KRYSTAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-946-6976",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "972-777-5274",
            "affiliation": "N",
            "endpointDescription": "FAX",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "9727775274",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "fax",
            "address_1": "1252 Todiway Ct",
            "city": "Jonesboro",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302386546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Prosthetic/Orthotic Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.