Provider Demographics
NPI:1326550492
Name:OPTIMAL HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:OPTIMAL HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALMON-ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:470-448-3177
Mailing Address - Street 1:2121 FOUNTAIN DR STE F
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2900
Mailing Address - Country:US
Mailing Address - Phone:470-448-3177
Mailing Address - Fax:
Practice Address - Street 1:2121 FOUNTAIN DR STE F
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078
Practice Address - Country:US
Practice Address - Phone:404-465-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003185262BMedicaid