Provider Demographics
NPI:1083154785
Name:IMAGE OF EVE RESTORED, INC
Entity Type:Organization
Organization Name:IMAGE OF EVE RESTORED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILITH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHYTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-937-7050
Mailing Address - Street 1:PO BOX 11384
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35814-1384
Mailing Address - Country:US
Mailing Address - Phone:256-937-7050
Mailing Address - Fax:
Practice Address - Street 1:185 WHITESPORT DR SW
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6486
Practice Address - Country:US
Practice Address - Phone:256-937-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty