Restore Wellness and Medspa LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

RESTORE WELLNESS AND MEDSPA LLC

Practice address

112 Rogers St NE Ste 1a
Atlanta, GA 30317-1094

Phone

(404) 890-5625

Fax

(404) 595-2547

NPI assigned

Dec 11, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kimberly Eide, MDNPI 1659908937

Title

Physician/Owner

Phone

(404) 910-6220

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Nichole Eide, MD

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1659908937
  Medicare reassignment NPD Authorized official
• Lori Ann Levine, NP

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1902214836
  Medicare reassignment NPD
• Britanie R Smith, NP

  • Family Nurse Practitioner
  • Atlanta, GA
  • NPI 1164305330
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1275349508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "665 GRADY PL SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303102615",
            "telephone_number": "404-910-6220",
            "fax_number": "404-595-2547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 ROGERS ST NE STE 1A",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303171094",
            "telephone_number": "404-890-5625",
            "fax_number": "404-595-2547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE WELLNESS AND MEDSPA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-11",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-10",
        "status": "A",
        "authorized_official_last_name": "EIDE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "404-910-6220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerry J. Ressler, MD,PHD
• Rested
• Restoration Behavioral Health, Inc
• Restorative Transits LLC
• Restore Health Group, Inc (Restore Neurobehavioral Center)
• Restore Wellness and Pain Management Center
• Restoring Hope Recovery Group, LLC
• Resurgence Educational Solutions, LLC
• Resurgens Surgery Center LLC
• Resurgens, LLC (Resurgens Orthopaedics)

• Family Medicine Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.