M3 Revival Inc

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

M3 REVIVAL INC

Practice address

5201 Nations Ford Rd Ste I
Charlotte, NC 28217-2023

Phone

(704) 900-5208

NPI assigned

May 1, 2024

Organization subpart

No

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

Authorized official

Name

Ravon Barnes

Title

Ceo

Phone

(704) 900-5208

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1714521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714521600000",
    "number": "1265289896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 NATIONS FORD RD STE I",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282172023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 NATIONS FORD RD STE I",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282172023",
            "telephone_number": "704-900-5208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "M3 REVIVAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "RAVON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "704-900-5208"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; 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.