NPIMap

Organization Active NPI

Restore First Health Marietta LLC

  • Family Medicine Physician
  • Marietta, GA
National Provider Identifier
1487378071
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RESTORE FIRST HEALTH MARIETTA LLC
Doing business as
Restore First Health Marietta LLC
Practice address
2550 Windy Hill Rd SE Ste 115
Marietta, GA 30067-8607
Phone
(678) 580-2684
NPI assigned
Sep 28, 2022
Last updated
Oct 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Authorized official

Name
Randall Lee Haupt
Title
Executive Vice President, Sgi
Phone
(470) 292-3820

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2550 Windy Hill Rd SE Ste 115
Marietta, GA 30067-8607

Mailing address

2550 Windy Hill Rd SE Ste 115
Marietta, GA 30067-8607
Phone (678) 580-2684

Other names 1

  • Restore First Health Marietta LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230518001702 GA Part B Supplier - Clinic/Group Practice 6305202268 Receives reassigned benefits from 11 practitioners
Practice locations: Marietta, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1487378071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE STE 115",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678607",
            "telephone_number": "678-580-2684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2550 WINDY HILL RD SE STE 115",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300678607",
            "telephone_number": "678-580-2684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE FIRST HEALTH MARIETTA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "HAUPT",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT, SGI",
        "authorized_official_telephone_number": "470-292-3820"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restore First Health Marietta LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Restore First Health Marietta LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.