| Revive Athletics, Inc | |
|
460 Bourne Drive Smyrna GA 30082 | |
| (770) 899-8187 | |
| Not Available |
| Full Name | Revive Athletics, Inc |
|---|---|
| Speciality | Speech-language Pathologist |
| Location | 460 Bourne Drive, Smyrna, Georgia |
| Authorized Official Name and Position | Matthew Harrell (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7708998187 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Athletics, Inc 2916 Lonesome Pine Lane Atlanta GA 30339-4114 Ph: () - | Revive Athletics, Inc 460 Bourne Drive Smyrna GA 30082 Ph: (770) 899-8187 |
| NPI Number | 1487964193 |
|---|---|
| Provider Enumeration Date | 10/15/2010 |
| Last Update Date | 10/15/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487964193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 235Z00000X | Speech-language Pathologist | (* (Not Available)) | Primary |
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