Provider Demographics
NPI:1538173596
Name:RESTORA MEDICAL CENTERS
Entity type:Organization
Organization Name:RESTORA MEDICAL CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-322-2271
Mailing Address - Street 1:PO BOX 541
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-0541
Mailing Address - Country:US
Mailing Address - Phone:706-322-2271
Mailing Address - Fax:706-322-2220
Practice Address - Street 1:5669 WHITESVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9054
Practice Address - Country:US
Practice Address - Phone:706-322-2271
Practice Address - Fax:706-322-2220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL#95558Medicare UPIN
65BBBGQMedicare ID - Type UnspecifiedPROVIDER NUMBER