Healthcare Provider Details

I. General information

NPI: 1366252462
Provider Name (Legal Business Name): OPTIMUM PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 CAVENDER DR SW
ATLANTA GA
30331-9423
US

IV. Provider business mailing address

7145 CAVENDER DR SW
ATLANTA GA
30331-9423
US

V. Phone/Fax

Practice location:
  • Phone: 404-902-0821
  • Fax: 855-450-1334
Mailing address:
  • Phone: 470-987-1512
  • Fax: 855-576-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: NANCY BELLINGER
Title or Position: NP
Credential:
Phone: 470-987-1512