Provider Demographics
NPI:1568116747
Name:RESTORATION WELLNESS AND MEDSPA
Entity Type:Organization
Organization Name:RESTORATION WELLNESS AND MEDSPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:615-243-8984
Mailing Address - Street 1:365 S HARTMANN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-4788
Mailing Address - Country:US
Mailing Address - Phone:615-243-8984
Mailing Address - Fax:
Practice Address - Street 1:365 S HARTMANN DR STE 104
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-4788
Practice Address - Country:US
Practice Address - Phone:615-243-8984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care