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General NPI Number Information
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NPI Number | 1922693282
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Entity Type | Organization
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Legal Business Name | RESTORE NON-SURGICAL REPLACEMENT CENTER INC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 3540 WHEELER RD STE 203
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City | AUGUSTA
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State | GA
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Zip | 30909-1879
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Country | US
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Telephone | 706-922-9800
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Fax | 706-922-9801
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Provider Business Mailing Address
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Address Line | 285 MAYWOOD DR
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City | MARTINEZ
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State | GA
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Zip | 30907-2226
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Country | US
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Telephone | 706-951-9633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TERRI BROWN
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Credential |
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Telephone | 706-951-9633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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