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RESTORE WELLNESS AND MEDSPA LLC
NPI 1275349508
Family Medicine in Atlanta, GA

Active since December 11, 2024CLIA 11D2307347 · Waiver
112 ROGERS ST NE STE 1A, ATLANTA, GA 30317(404) 890-5625(404) 595-2547 Get Directions Write a Review

NPPES record last updated: December 11, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Restore Wellness And Medspa Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RESTORE WELLNESS AND MEDSPA LLC (NPI 1275349508) is a healthcare organization registered as a family medicine in Atlanta, Georgia and active in the NPI registry since December 2024. The organization holds a CLIA Waiver certificate valid through July 7, 2028 and lists Kimberly Eide, Physician/owner, as its authorized official.

NPPES Registry Identity

NPI1275349508
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameRESTORE WELLNESS AND MEDSPA LLC
Location Address112 ROGERS ST NE STE 1AAtlanta, GA 30317-1094
Mailing Address665 Grady Pl SwAtlanta, GA 30310-2615 · (404) 910-6220 · Fax (404) 595-2547
Phone(404) 890-5625
Fax(404) 595-2547
Organization SubpartNo
Authorized OfficialKimberly EidePhysician/owner · (404) 910-6220
Enumeration DateDecember 11, 2024
NPPES CertifiedDecember 10, 2024
✔ NPI 1275349508 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
112 ROGERS ST NE STE 1A, Atlanta, GA 30317
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Restore Wellness And Medspa Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Restore Wellness And Medspa LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Kimberly Eide, MD
Family Practice
NPI 1659908937
112 ROGERS ST NE STE 1A
Atlanta, GA 30317
(404) 890-5625
✔ PECOS✔ Accepts Medicare0.1 mi
Lori Levine, NP
Family Practice
NPI 1902214836
1015 DONALD LEE HOLLOWELL PKWY NW
Atlanta, GA 30318
(404) 523-6571
✔ PECOS✔ Accepts Medicare5.3 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2307347

Restore Wellness And Medspa · Atlanta, GA
Active · expires Jul 7, 2028
CLIA Number11D2307347
Laboratory TypePhysician Office
Certificate Effective DateJuly 8, 2026
Certificate Expiration DateJuly 7, 2028
Laboratory DirectorKimberly N. Eide
Laboratory Phone(404) 910-6220
Laboratory LocationRestore Wellness And Medspa112 Rogers Street, NE, Suite 1 A, Atlanta, GA 30317
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Restore Wellness And Medspa LLC's NPI number?

The NPI number for Restore Wellness And Medspa LLC is 1275349508. It was assigned to this organization in the NPPES registry on December 11, 2024.

Where is Restore Wellness And Medspa LLC located?

Restore Wellness And Medspa LLC is located at 112 Rogers St NE Ste 1A, Atlanta, GA 30317. The listed phone number is (404) 890-5625.

What is Restore Wellness And Medspa LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Restore Wellness And Medspa LLC enrolled in Medicare?

Yes. Restore Wellness And Medspa LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Restore Wellness And Medspa LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Family Practice, reassign their Medicare billing to Restore Wellness And Medspa LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Restore Wellness And Medspa LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2307347) is associated with this NPI, valid through July 7, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Restore Wellness And Medspa LLC was last updated on December 11, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.