Revive MD

Primary specialty

Obesity Medicine (Obstetrics & Gynecology) PhysicianTaxonomy code 207VB0002X

License

26575 Issued in TN

Legal business name

REVIVE MD

Practice address

1804 Williamson CT
Suite 107
Brentwood, TN 37027-8170

Phone

(615) 690-6600

Fax

(615) 690-6604

NPI assigned

Jun 16, 2010

Organization subpart

No

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

Authorized official

Name

Daphne Baker Lodge, RN

Title

President

Phone

(615) 690-6600

Specialties & licenses 1

Addresses

Other names 1

• BlueSky MD Doing business as

Locations

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

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1700107547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 WILLIAMSON CT",
            "address_2": "SUITE 107",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278170",
            "telephone_number": "615-690-6600",
            "fax_number": "615-690-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 WILLIAMSON CT",
            "address_2": "SUITE 107",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278170",
            "telephone_number": "615-690-6600",
            "fax_number": "615-690-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "LODGE",
        "authorized_official_first_name": "DAPHNE",
        "authorized_official_middle_name": "BAKER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-690-6600",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207VB0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Obesity Medicine",
            "state": "TN",
            "license": "26575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BlueSky MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Results-Ast JV, LLC
• Reviresco Counseling, LLC
• Jerry Reyes-Rivera, CNIM
• Cheyenne Reyes
• Kelly Marie Reynolds
• Melissa G Reynolds, M.D.
• Lacey Rhames Ross

• Obesity Medicine (Obstetrics & Gynecology) Physician in Brentwood, TN
• Providers in Brentwood, TN by specialty
• Obesity Medicine (Obstetrics & Gynecology) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; 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.