REVIVE ATHLETICS, INC (NPI# 1487964193) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487964193 |
| Entity Type | Organization |
| Organization Name | REVIVE ATHLETICS, INC |
| Practice Address |
460 Bourne Drive Smyrna GA 30082 |
| Mailing Address |
2916 Lonesome Pine Lane Atlanta GA 30339-4114 |
| Practice Telephone | 7708998187 |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2010-10-15 |
| Authorized Official Name | MATTHEW HARRELL (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7708998187 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| Y | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669855177 | Revive Athletics, Inc | Community/Behavioral Health | 201 St. Charles Ave., Ste. 2500, New Orleans, LA 70170-2500 | 2015-07-01 |
| Street Address |
460 BOURNE DRIVE |
| City | SMYRNA |
| State | GA |
| Zip Code | 30082 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528600335 | Arden Constance Mobley | Occupational Therapist | 3200 Highlands Parkway Suite 150, Smyrna, GA 30082 | 2019-10-14 |
| 1386185916 | Nicholas Andrews | Behavior Technician | 5034 Laurel Bridge, Smyrna, GA 30082 | 2017-03-15 |
| 1518331362 | Shannon Wilkerson | Counselor | 3040 Highlands Pkwy, Ste G, Smyrna, GA 30082 | 2015-11-17 |
| 1235529611 | Frances Offiah Idowu | Nurse Practitioner | 3240 South Cobb Drive, Smyrna, GA 30082 | 2015-01-23 |
| 1053717850 | Deena Altman Spital | Physician Assistant | 400 Technology Ct, Suite J, Smyrna, GA 30082 | 2014-11-06 |
| 1386956746 | Kalpit C Patel | Family Medicine | 4480 N Cooper Lake Rd Se Ste 100, Smyrna, GA 30082 | 2010-07-13 |
| 1285826800 | David Goziem Nwabunor | Emergency Medicine | 415 Oak Brook Ct Se, Smyrna, GA 30082 | 2007-08-16 |
| 1437357373 | Amit M Patel | Plastic Surgery | 3968 Felton Hill Rd Sw, Ste 100, Smyrna, GA 30082 | 2007-07-03 |
| 1225103849 | Daniel C Norris Dds PC | Dentist | 620 Concord Rd, Smyrna, GA 30082 | 2006-11-21 |
| 1215001888 | Wellstar Urgent Care At Cooper Lake, LLC | Emergency Medicine | 4480 N Cooper Lake Road Se, Suite 100, Smryna, GA 30082 | 2006-11-17 |
| Find all providers in zip 30082 | ||||
| Taxonomy Code | 235Z00000X |
| Grouping | Speech, Language and Hearing Service Providers |
| Classification | Speech-Language Pathologist |
| The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing. |
| Notes: "Scope of Practice in Speech-Language Pathology", American Speech-Language-Hearing Association, 2013. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609481993 | Valeria Gary | Speech-Language Pathologist | 5200 Laurel Bridge Ct Se, Smyrna, GA 30082-4827 | 2020-09-13 |
| 1548824816 | Kristen M Menapace | Speech-Language Pathologist | 703 Country Park Dr Se, Smyrna, GA 30080-8221 | 2019-04-23 |
| 1225593072 | Laura Porto | Speech-Language Pathologist | 605 Glendale Pl Se, Smyrna, GA 30080-1835 | 2019-02-06 |
| 1366993073 | Megan Morrow | Speech-Language Pathologist | 3905 Cherrydale Ln Se, Smyrna, GA 30082-3311 | 2016-10-18 |
| 1710352059 | Krsiten Schneider | Speech-Language Pathologist | 5075 Fairmont Rd Se, Smyrna, GA 30082-5112 | 2015-12-12 |
| 1518210210 | Kelly L Walsh | Speech-Language Pathologist | 4810 Ivy Ridge Dr Se, Unit 306, Smyrna, GA 30080-6660 | 2012-10-18 |
| 1649536640 | Primary Pathways, LLC | Speech-Language Pathologist | 1258 Concord Rd Se Ste 104, Smyrna, GA 30080-4302 | 2012-04-04 |
| 1609145960 | Stephanie V Coleman | Speech-Language Pathologist | 3606 Locklyn Ln Se, Smyrna, GA 30080-2395 | 2011-12-15 |
| 1356620066 | Misty Vanlandingham Fountain | Speech-Language Pathologist | 1685 Harlington Rd, Smyrna, GA 30082-5052 | 2011-08-11 |
| 1821395120 | Tazmerai Quesinberry | Speech-Language Pathologist | 901 Woodlands Dr Se, Smyrna, GA 30080-2483 | 2011-02-22 |
| Find all providers in SMYRNA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.