Provider Demographics
NPI:1235929613
Name:AWAKEN,INSPIRE,RESTORE LLC
Entity type:Organization
Organization Name:AWAKEN,INSPIRE,RESTORE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TASHINEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNADIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-803-2445
Mailing Address - Street 1:140 ASTRAL CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2595
Mailing Address - Country:US
Mailing Address - Phone:904-803-2445
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2182
Practice Address - Country:US
Practice Address - Phone:770-809-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-09
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty