Provider Demographics
NPI:1306211529
Name:OPTIM ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:OPTIM ORTHOPEDICS, LLC
Other - Org Name:OPTIM ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-1626
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:ATTN.: ALIA MIKE
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-1626
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:821 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0164
Practice Address - Country:US
Practice Address - Phone:912-637-5486
Practice Address - Fax:912-367-8428
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIM ORTHOPEDICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty