MEDICARE: RESTORE METABOLIX WATKINSVILLE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1164184099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESTORE METABOLIX WATKINSVILLE LLC

Provider Business Mailing Address
First Line	:	1741 HOG MOUNTAIN ROAD
Second Line	:	BUILDING 200C
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677
Country	:	US
Telephone Number	:	706-715-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1741 HOG MOUNTAIN ROAD
Second Line	:	BUILDING 200C
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677
Country	:	US
Telephone Number	:	706-715-3287
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JACK WRIGHT
Credential	:
Telephone Number	:	706-248-8456

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	01/20/2026

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