11D2307347 CLIA NUMBER - RESTORE WELLNESS AND MEDSPA

Laboratory Demographics

  • CLIA Code: 11D2307347
  • Facility Name: RESTORE WELLNESS AND MEDSPA
  • Facility Address: 112 ROGERS STREET, NE, SUITE 1 A
    ATLANTA, GA
    ZIP 30317
  • Facility Phone: 404 910-6220
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KIMBERLY N. EIDE
  • NPI Number: 1275349508
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 11D2307347
LAB Type Physician Office
Facility Name RESTORE WELLNESS AND MEDSPA
Street 112 ROGERS STREET, NE, SUITE 1 A
City ATLANTA
State GA
ZIP 30317
Phone 404 910-6220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2024
Certificate Expiration Date 7/7/2026
Facility Type Physician Office
Lab Director KIMBERLY N. EIDE

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This page was last updated on: 9/29/2025