Provider Demographics
NPI:1770859597
Name:OPTIMAL OUTCOMES HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:OPTIMAL OUTCOMES HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MHA, CPUR, CCM
Authorized Official - Phone:770-474-9086
Mailing Address - Street 1:684 PATHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7787
Mailing Address - Country:US
Mailing Address - Phone:770-474-9086
Mailing Address - Fax:877-522-1977
Practice Address - Street 1:684 PATHWOOD LN
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7787
Practice Address - Country:US
Practice Address - Phone:770-474-9086
Practice Address - Fax:877-522-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251B00000X, 251J00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare