MEDICARE: RESTORED HEALTH INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	939881908A	OTHER	GA	GBHC

General Provider Information

NPI Number	:	1225242308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORED HEALTH INC.

Provider Business Mailing Address
First Line	:	590 BARONY CV
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-3085
Country	:	US
Telephone Number	:	678-699-1332
Fax Number	:	678-482-1134

Provider Business Practice Location Address
First Line	:	483 INDIAN TRAIL LILBURN RD NW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-3717
Country	:	US
Telephone Number	:	770-923-4433
Fax Number	:

Authorized Official
Title or Position	:	M.D.
Name	:	KIRPICH JOSEPH
Credential	:
Telephone Number	:	678-699-1332

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	12/10/2024

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Directions to “RESTORED HEALTH INC. ” Practice Location

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