Healthcare Provider Details

I. General information

NPI: 1770740201
Provider Name (Legal Business Name): OPTIMUM NUTRITION CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 ARMOUR RD STE 200
COLUMBUS GA
31904-5038
US

IV. Provider business mailing address

4923 ARMOUR RD STE 200
COLUMBUS GA
31904-5038
US

V. Phone/Fax

Practice location:
  • Phone: 800-351-6659
  • Fax: 706-322-1804
Mailing address:
  • Phone: 800-351-6659
  • Fax: 706-322-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL EUGENE SECKINGER SR.
Title or Position: PRESIDENT/CEO
Credential: C.N., N.D.
Phone: 18003516659