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General NPI Number Information
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NPI Number | 1669353942
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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 | 09/11/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 100 TOWNCENTER BLVD STE 111
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1832
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Country | US
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Telephone | 205-330-8820
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1005
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City | FAYETTE
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State | AL
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Zip | 35555-1090
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT BOLLING
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Credential | MD
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Telephone | 205-442-4986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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