11D2246645 CLIA NUMBER - RESTOR METABOLIX OF BLACKSHEAR

Laboratory Demographics

CLIA Number: 11D2246645

Facility Name: RESTOR METABOLIX OF BLACKSHEAR

Facility Address:
3345 US HIGHWAY 84 WEST UNIT 102
BLACKSHEAR, GA
ZIP 31516
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Facility Phone Number: 912 208-3581

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1174287379

Taxonomy: 207RE0101X - Internal Medicine
An internist who concentrates on disorders of the internal (endocrine) glands such as the thyroid and adrenal glands. This specialist also deals with disorders such as diabetes, metabolic and nutritional disorders, obesity, pituitary diseases and menstrual and sexual problems.

CLIA Record

Field Name	Field Value
CLIA Number	11D2246645
LAB Type	Physician Office
Facility Name	RESTOR METABOLIX OF BLACKSHEAR
Street	3345 US HIGHWAY 84 WEST UNIT 102
City	BLACKSHEAR
State	GA
ZIP	31516
Phone	912 208-3581
CertificateType	4
CertificateEffectiveDate	12/28/2023
CertificateExpirationDate	12/27/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024