Provider Demographics
NPI:1922693282
Name:RESTORE NON-SURGICAL REPLACEMENT CENTER INC
Entity Type:Organization
Organization Name:RESTORE NON-SURGICAL REPLACEMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-951-9633
Mailing Address - Street 1:285 MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2226
Mailing Address - Country:US
Mailing Address - Phone:706-951-9633
Mailing Address - Fax:
Practice Address - Street 1:3540 WHEELER RD STE 203
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1879
Practice Address - Country:US
Practice Address - Phone:706-922-9800
Practice Address - Fax:706-922-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty