Revival Wound Specialists LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

REVIVAL WOUND SPECIALISTS LLC

Practice address

302 Bermuda RDG
Perry, GA 31069-8756

Phone

(470) 979-7018

NPI assigned

Jan 9, 2026

Last updated

Jan 9, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dat Le, NPNPI 1194397265

Title

Owner

Phone

(470) 979-7018

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dat Thanh Le, FNP-C

  • Family Nurse Practitioner
  • Clearwater, FL
  • NPI 1194397265
  NPD Authorized official

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

{
    "created_epoch": "1767916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767916800000",
    "number": "1689531709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 BERMUDA RDG",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310698756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 BERMUDA RDG",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310698756",
            "telephone_number": "470-979-7018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL WOUND SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-09",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "DAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "470-979-7018",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Russell Purvis, MD
• Pulipaka B Rao, M.D.
• Elena Resendiz, FNP
• Resilient Minds Psychiatric Care of Middle Georgia LLC
• Hannah Revell, FNP-C
• Kaley Clark Reynolds
• Sophia Monique Roberts, MS
• Amanda Joy Rogers
• Clayton Reese Rountree
• Jalisa Nicole Rumph, LCSW

• Nurse Practitioner in Perry, GA
• Providers in Perry, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2026; 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.