Restore Health PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

18239 Issued in MS

Legal business name

RESTORE HEALTH PLLC

Doing business as

Restore Health Clinic

Practice address

1551 E County Line Rd
Jackson, MS 39211-1801

Phone

(601) 957-7343

Fax

(601) 957-7344

NPI assigned

Dec 9, 2015

Organization subpart

No

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

Authorized official

Name

Shinita Reed Dudley, M.D.

Title

Owner

Phone

(601) 957-7343

Specialties & licenses 1

Addresses

Other names 1

• Restore Health Clinic Doing business as

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12707/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1449619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460073600000",
    "number": "1699140152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 E COUNTY LINE RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392111801",
            "telephone_number": "601-957-7343",
            "fax_number": "601-957-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 E COUNTY LINE RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392111801",
            "telephone_number": "601-957-7343",
            "fax_number": "601-957-7344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE HEALTH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-09",
        "last_updated": "2016-04-08",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "SHINITA",
        "authorized_official_middle_name": "REED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-957-7343",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "18239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restore Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Resolution Counseling Services, PLLC
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• Restoration Counseling Services, LLC
• Restoration Rehab Inc
• Restore Counseling and Consulting Services
• Hazan Retana, BA, PSYCHOLOGY
• Robert Kennedy Revere, DDS
• Jonathan Reves, D.O.
• Lindsay Elizabeth Rexrode, MD
• Roberto Rey Dios, M.D.

• Primary Care Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.