Healthcare Provider Details

I. General information

NPI: 1497278147
Provider Name (Legal Business Name): OPTIMUM FOOT AND ANKLE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W PARK PLACE BLVD STE 122
STONE MOUNTAIN GA
30087-3561
US

IV. Provider business mailing address

2300 W PARK PLACE BLVD STE 122
STONE MOUNTAIN GA
30087-3561
US

V. Phone/Fax

Practice location:
  • Phone: 470-292-7116
  • Fax: 678-786-1208
Mailing address:
  • Phone: 470-207-0700
  • Fax: 470-207-0702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000853
License Number StateGA

VIII. Authorized Official

Name: DR. FELICIA DIANE PIERRE
Title or Position: PHYSICIAN OWNER
Credential: DPM
Phone: 404-630-5534