Revive Wound Care Ga LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

REVIVE WOUND CARE GA LLC

Practice address

980 Rowland St
Ste 5140 #1111
Clarkston, GA 30021

Phone

(951) 760-6216

NPI assigned

Oct 24, 2024

Organization subpart

No

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

Authorized official

Name

Paul Davis

Title

Manager

Phone

(951) 760-6216

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Johannes M. Neuendorf, D.O.

  • Emergency Medicine Physician
  • La Jolla, CA
  • NPI 1154388601
  NPD (past)

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

{
    "created_epoch": "1729728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1548082274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 ROWLAND ST",
            "address_2": "STE 5140 #1111",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "30021",
            "telephone_number": "951-760-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 ROWLAND ST",
            "address_2": "STE 5140 #1111",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "30021",
            "telephone_number": "951-760-6216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE WOUND CARE GA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-24",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "951-760-6216"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Precision Clinical Imaging Pci LLC
• Premier Orthotics & Prosthetics, Inc
• Quality One Home Healthcare, LLC
• Preethi Rajan
• Asmita Raut
• Robert H. Baker
• Nida Rupani, F.N.P-C
• Safe Non-Emergency Transportation Inc.
• Rebekah Schicker, RN, NP-C
• Scooter Chair Repair Georgia, LLC

• General Practice Physician in Clarkston, GA
• Providers in Clarkston, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 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.