Provider Demographics
NPI:1699359174
Name:OPTIMUM PODIATRY LLC
Entity Type:Organization
Organization Name:OPTIMUM PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:COWANS
Authorized Official - Suffix:II
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-727-0614
Mailing Address - Street 1:5077 DALLAS HWY STE 311
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4510
Mailing Address - Country:US
Mailing Address - Phone:770-727-0614
Mailing Address - Fax:770-799-8453
Practice Address - Street 1:5077 DALLAS HWY STE 311
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-4510
Practice Address - Country:US
Practice Address - Phone:770-727-0614
Practice Address - Fax:770-799-8453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-10
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty