Healthcare Provider Details

I. General information

NPI: 1730573841
Provider Name (Legal Business Name): OPTIM ORTHOPEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 TOWNE PARK DR STE 200
RINCON GA
31326-5167
US

IV. Provider business mailing address

210 E DERENNE AVE ATTN.: PROVIDER ENROLLMENT
SAVANNAH GA
31405-6736
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-2533
  • Fax: 912-826-2572
Mailing address:
  • Phone: 912-644-5300
  • Fax: 912-644-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MIKE BUTLER
Title or Position: CEO
Credential:
Phone: 912-644-5300