Revivify Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

REVIVIFY MEDICAL SUPPLY LLC

Practice address

3200 N Henry Blvd Ste C
Stockbridge, GA 30281-4666

Phone

(504) 612-4202

NPI assigned

May 29, 2024

Organization subpart

No

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

Authorized official

Name

Kristina Adah

Title

Owner

Phone

(504) 612-4202

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

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

{
    "created_epoch": "1716940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716940800000",
    "number": "1306686274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 N HENRY BLVD STE C",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814666",
            "telephone_number": "504-612-4202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 N HENRY BLVD STE C",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302814666",
            "telephone_number": "504-612-4202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVIFY MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-29",
        "last_updated": "2024-05-29",
        "certification_date": "2024-05-29",
        "status": "A",
        "authorized_official_last_name": "ADAH",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-612-4202"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renaissance Relations, Inc
• Renal Treatment Centers Mid Atlantic Inc (Spivey Peritoneal and Home Dialysis Center)
• Renu Wound Care LLC
• Resourceful Home Care Services, LLC
• Revive Orthopedics Spine & Sports Medicine, Inc (Revive Orthopedics Spine & Sports Medicine)
• Rey of Life Homecare Services LLC
• Elysia Hymon Reynolds, DNP, APRN, FNP-C
• Erica Reynolds
• Michael Paul Errington Reynolds
• Shahram Rezaiamiri, M.D.

• Durable Medical Equipment & Medical Supplies in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2024; 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.