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General NPI Number Information
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NPI Number | 1588274708
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Entity Type | Organization
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Legal Business Name | RESTORATION CLINIC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 17619 STATE HIGHWAY 58 N STE C
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City | DECATUR
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State | TN
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Zip | 37322-7882
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Country | US
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Telephone | 423-506-3781
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Fax | 423-454-0125
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Provider Business Mailing Address
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Address Line | PO BOX 1094
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City | DECATUR
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State | TN
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Zip | 37322-1094
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Country | US
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Telephone | 423-334-2300
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Fax | 423-454-0125
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ENGLISH ROBERTS
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Credential | FNP
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Telephone | 423-506-3781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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