Revive Medical USA Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

REVIVE MEDICAL USA INC

Practice address

2926 Mountain Industrial Blvd
Tucker, GA 30084-3012

Phone

(678) 379-1731

Fax

(678) 248-2377

NPI assigned

Sep 1, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Gurleen Kaur, MDNPI 1447529441

Title

President

Phone

(708) 860-8111

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gurleen Kaur, M.D.

  • Primary Care Clinic/Center
  • Gainesville, GA
  • NPI 1447529441

  Internal Medicine

  Medicare reassignment Care Compare group NPD Authorized official
• Sonu Gupta, MD

  • Primary Care Clinic/Center
  • Braselton, GA
  • NPI 1568727220

  Internal Medicine

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1661990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1245950930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4474 VALTEK CT",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246209",
            "telephone_number": "708-300-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2926 MOUNTAIN INDUSTRIAL BLVD",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300843012",
            "telephone_number": "678-379-1731",
            "fax_number": "678-248-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICAL USA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-01",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "KAUR",
        "authorized_official_first_name": "GURLEEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-860-8111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.revivemedicalusa.com",
            "affiliation": "N",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2926 Mountain Industrial Blvd",
            "city": "Tucker",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300843012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Danica Samuels Reuter, LCSW
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• Catherine Reynolds, PSY.D.
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• Sharon Lee Rhodes, MS, RD, LD
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• Anglea Steele Rice, MA, JD, LPC, NCC,CRC

• Primary Care Clinic/Center in Tucker, GA
• Providers in Tucker, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.