| Revive Concierge & Wellness Pllc | |
|
906 S Main St Burlington NC 27215-5757 | |
| (336) 935-1240 | |
| (336) 234-1020 |
| Full Name | Revive Concierge & Wellness Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 906 S Main St, Burlington, North Carolina |
| Authorized Official Name and Position | Chrystal Gammon (OWNER) |
| Authorized Official Contact | 4344292383 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Concierge & Wellness Pllc Po Box 116 Sedalia NC 27342-0116 Ph: (336) 266-7899 | Revive Concierge & Wellness Pllc 906 S Main St Burlington NC 27215-5757 Ph: (336) 935-1240 |
| NPI Number | 1942904818 |
|---|---|
| Provider Enumeration Date | 03/27/2023 |
| Last Update Date | 04/18/2023 |
| Medicare PECOS PAC ID | 5799141461 |
|---|---|
| Medicare Enrollment ID | O20230523000741 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942904818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Lee Anthony Dudley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215960026 PECOS PAC ID: 2365335288 Enrollment ID: I20130916000724 |
| Provider Name | Chrystal D Gammon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073165148 PECOS PAC ID: 2365876729 Enrollment ID: I20191218002271 |
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