| NPI | 1811728314 |
|---|---|
| Doing Business As | MEDIVIVE |
| Entity Type | Organization |
| Authorized Contact | SHANNON MACHELLE SMITH Owner 704-451-1084 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2024-08-08 |