Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Revitalife, Inc

Organization Obesity Medicine (Internal Medicine) Physician · NPI 1104504406

Revitalife, Inc is an Obesity Medicine (Internal Medicine) Physician in Cumming, Georgia. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
Inc — Incorporated
A form of business registration, not a clinical qualification.

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Practice location Address checks out

102 Mary Alice Park Rd Ste 402
Cumming, GA 30040-2692
Phone: (770) 744-1409
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obesity Medicine (Internal Medicine) Physician (primary) Taxonomy 207RB0002X

Record details

NPI number1104504406
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Davia Ward — Ceo · (770) 744-1409
Other names Revitalife Weight Loss Clinics
NPI enumeratedJuly 6, 2023
Last updated in NPPESJuly 6, 2023
Certification dateJuly 6, 2023
Mailing address102 Mary Alice Park Rd Ste 402, Cumming, GA 30040-2692