Healthcare Provider Details

I. General information

NPI: 1770859597
Provider Name (Legal Business Name): OPTIMAL OUTCOMES HEALTHCARE NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 PATHWOOD LN
STOCKBRIDGE GA
30281-7787
US

IV. Provider business mailing address

684 PATHWOOD LN
STOCKBRIDGE GA
30281-7787
US

V. Phone/Fax

Practice location:
  • Phone: 770-474-9086
  • Fax: 877-522-1977
Mailing address:
  • Phone: 770-474-9086
  • Fax: 877-522-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. DONNA LYNN ROSS
Title or Position: PRESIDENT/CEO
Credential: RN, MHA, CPUR, CCM
Phone: 770-474-9086