Provider Demographics
NPI:1952904369
Name:RESTORED HEALTH & WELLNESS
Entity Type:Organization
Organization Name:RESTORED HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRPICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-699-1332
Mailing Address - Street 1:771 OLD NORCROSS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4386
Mailing Address - Country:US
Mailing Address - Phone:503-806-4714
Mailing Address - Fax:
Practice Address - Street 1:483 INDIAN TRAIL LILBURN RD NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3717
Practice Address - Country:US
Practice Address - Phone:770-923-4433
Practice Address - Fax:770-797-5162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA792206505AMedicaid