Provider Demographics
NPI:1225616618
Name:BUILD AND RESTORE
Entity Type:Organization
Organization Name:BUILD AND RESTORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLONNERY-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:912-217-3371
Mailing Address - Street 1:139 ALTAMA CONNECTOR # 113
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1888
Mailing Address - Country:US
Mailing Address - Phone:850-210-2473
Mailing Address - Fax:
Practice Address - Street 1:112 HEATHERLY WAY
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-8958
Practice Address - Country:US
Practice Address - Phone:912-217-3371
Practice Address - Fax:833-520-1516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty