# RESTORE WELLNESS AND MEDSPA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275349508
- **Authorized official:** DR. KIMBERLY EIDE MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (404) 910-6220

## Contact information

- **Practice address:** 112 ROGERS ST NE STE 1A, ATLANTA, GA 30317-1094
- **Practice address phone:** (404) 890-5625
- **Practice address fax:** (404) 595-2547
- **Mailing address:** 665 GRADY PL SW, ATLANTA, GA 30310-2615
- **Mailing address phone:** (404) 910-6220
- **Mailing address fax:** (404) 595-2547

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/11/2024
- **Last updated:** 12/11/2024