Healthcare Provider Details

I. General information

NPI: 1164285151
Provider Name (Legal Business Name): OPTIMAL INTEGRATIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3193 HOWELL MILL RD NW STE 125
ATLANTA GA
30327-2100
US

IV. Provider business mailing address

PO BOX 550428
ATLANTA GA
30355-2928
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-1223
  • Fax: 404-352-1226
Mailing address:
  • Phone: 404-352-1223
  • Fax: 404-352-1226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: SHARON PAGE DICKERSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 404-352-1223