Revivere Nutrition

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Legal business name

REVIVERE NUTRITION

Practice address

514 Silver Maple LN
Woodstock, GA 30189-6907

Phone

(978) 304-2794

NPI assigned

Mar 5, 2025

Organization subpart

No

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

Authorized official

Name

Caroline Grosch, RD, LD, CNSCNPI 1588357818

Title

Registered Dietitian

Phone

(978) 304-2794

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Caroline Grosch, RD, LD, CNSC

  • Registered Dietitian
  • Atlanta, GA
  • NPI 1588357818

  Dietitian, Registered

  NPD Authorized official

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

{
    "created_epoch": "1741132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1417755398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 SILVER MAPLE LN",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896907",
            "telephone_number": "978-304-2794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 SILVER MAPLE LN",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896907",
            "telephone_number": "978-304-2794"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "240 N Highland Ave NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303075609",
            "country_code": "US",
            "telephone_number": "978-304-2794",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "REVIVERE NUTRITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-05",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "GROSCH",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "REGISTERED DIETITIAN",
        "authorized_official_telephone_number": "978-304-2794",
        "authorized_official_credential": "RD, LD, CNSC"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770368060",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jay Brian Reznick, MD, DMD
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• Registered Dietitian in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Registered Dietitian in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.