Awaken,Inspire,Restore LLC
Organization Active NPI Family Medicine Physician · Newnan, GA
NPI 1235929613 · NPPES record last updated May 29, 2025
Key facts
- NPI
- 1235929613
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- AWAKEN,INSPIRE,RESTORE LLC
- Practice address
- 1111 Highway 34 E
Newnan, GA 30265-2182 - Phone
- (770) 809-1100
- NPI assigned
- May 9, 2025
- Organization subpart
- No
Authorized official
- Name
- Tashinea Bernadin, DO
- Title
- Owner
- Phone
- (904) 803-2445
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2329428 | Awaken Inspire Restore LLC | Certificate of waiver | Aug 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250930002835 | GA | Part B Supplier - Clinic/Group Practice | 5799281689 |
Receives reassigned benefits from 1 practitioner Practice locations: Newnan, GA |
National Provider Directory
Locations
1111 Highway 34 E
Newnan, GA 30265
Phone (770) 683-3739
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1111 Highway 34 E
Newnan, GA 30265-2182
Mailing address
140 Astral CT
Fayetteville, GA 30214-2595
Phone (904) 803-2445
Other providers in Newnan, GA
- Avalon Health Care LLC
- Conelia Stacie Avery
- Shanetia Sontavia Avinger
- Jaiwantkumar M Avula
- Rohit Kumar Avula
- Mark E Axness
- Jared Babb
- Baby Dimensions
- Eliza Johnson Bacot
- Idrissatu Bah
All providers in Newnan, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.