Provider Demographics
NPI:1275946600
Name:OPTIMUM HEALTH REHAB OF BUFORD LLC
Entity Type:Organization
Organization Name:OPTIMUM HEALTH REHAB OF BUFORD LLC
Other - Org Name:OPTIMUM HEALTH OF BUFORD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-730-6240
Mailing Address - Street 1:2133 HIGHWAY 317 STE 12-318
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2649
Mailing Address - Country:US
Mailing Address - Phone:678-714-3059
Mailing Address - Fax:678-714-3063
Practice Address - Street 1:4125 HIGHWAY 20 # R14
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3459
Practice Address - Country:US
Practice Address - Phone:678-714-3053
Practice Address - Fax:678-714-3063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty