Provider Demographics
NPI:1578933453
Name:OPTIMUS ULTRASOUND LLC
Entity Type:Organization
Organization Name:OPTIMUS ULTRASOUND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-621-2100
Mailing Address - Street 1:1005 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-6141
Mailing Address - Country:US
Mailing Address - Phone:478-621-2100
Mailing Address - Fax:478-744-0481
Practice Address - Street 1:252 HOLT AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1227
Practice Address - Country:US
Practice Address - Phone:478-742-4098
Practice Address - Fax:877-455-7176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIMUS DIAGNOSTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-05
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile