Provider Demographics
NPI:1497278147
Name:OPTIMUM FOOT AND ANKLE CENTERS LLC
Entity Type:Organization
Organization Name:OPTIMUM FOOT AND ANKLE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-630-5534
Mailing Address - Street 1:2300 W PARK PLACE BLVD STE 122
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3561
Mailing Address - Country:US
Mailing Address - Phone:470-207-0700
Mailing Address - Fax:470-207-0702
Practice Address - Street 1:2300 W PARK PLACE BLVD STE 122
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3561
Practice Address - Country:US
Practice Address - Phone:470-292-7116
Practice Address - Fax:678-786-1208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000853213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty