Provider Demographics
NPI:1770287757
Name:REVELS, AKWIASDI KAYE
Entity type:Individual
Prefix:
First Name:AKWIASDI
Middle Name:KAYE
Last Name:REVELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 WEISNER RD
Mailing Address - Street 2:
Mailing Address - City:OLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28660-9486
Mailing Address - Country:US
Mailing Address - Phone:704-682-7197
Mailing Address - Fax:
Practice Address - Street 1:1516 DEEP RIVER ROAD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265
Practice Address - Country:US
Practice Address - Phone:704-682-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies