Provider Demographics
NPI:1205954526
Name:RESTORE HEALTH GROUP, INC
Entity type:Organization
Organization Name:RESTORE HEALTH GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LENNON
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-563-8248
Mailing Address - Street 1:200 GALLERIA PKWY SE
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5918
Mailing Address - Country:US
Mailing Address - Phone:770-563-8248
Mailing Address - Fax:770-563-8221
Practice Address - Street 1:200 GALLERIA PKWY SE
Practice Address - Street 2:SUITE 1800
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5918
Practice Address - Country:US
Practice Address - Phone:678-277-9275
Practice Address - Fax:770-641-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062-012283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00937186AMedicaid