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General NPI Number Information
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NPI Number | 1487378071
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Entity Type | Organization
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Legal Business Name | RESTORE FIRST HEALTH MARIETTA LLC
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 2550 WINDY HILL RD SE STE 115
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City | MARIETTA
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State | GA
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Zip | 30067-8607
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Country | US
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Telephone | 678-580-2684
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 WINDY HILL RD SE STE 115
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City | MARIETTA
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State | GA
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Zip | 30067-8607
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Country | US
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Telephone | 678-580-2684
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT, SGI
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Name | RANDALL LEE HAUPT
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Credential |
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Telephone | 470-292-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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