Provider Demographics
NPI:1225242308
Name:RESTORED HEALTH INC.
Entity Type:Organization
Organization Name:RESTORED HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:KIRPICH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-699-1332
Mailing Address - Street 1:590 BARONY CV
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3085
Mailing Address - Country:US
Mailing Address - Phone:678-699-1332
Mailing Address - Fax:678-482-1134
Practice Address - Street 1:590 BARONY CV
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-3085
Practice Address - Country:US
Practice Address - Phone:678-699-1332
Practice Address - Fax:678-699-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA792206505AMedicaid
GA939881908AOtherGBHC
GA08BBRQVMedicare ID - Type Unspecified
GA792206505AMedicaid