Provider Demographics
NPI:1851084313
Name:INSTITUTE OF RESTORATIVE MEDICINE, LLC
Entity Type:Organization
Organization Name:INSTITUTE OF RESTORATIVE MEDICINE, LLC
Other - Org Name:INSTITUTE OF RESTORATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:GIOVINCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:678-561-9000
Mailing Address - Street 1:1975 HIGHWAY 54 W STE 205
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-902-0457
Mailing Address - Fax:770-415-1450
Practice Address - Street 1:7130 MOUNT ZION BLVD STE 13
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2566
Practice Address - Country:US
Practice Address - Phone:770-478-3668
Practice Address - Fax:770-478-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty