Healthcare Provider Details

I. General information

NPI: 1386038057
Provider Name (Legal Business Name): OPTIM ORTHOPEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 MEADOWS LANE
VIDALIA GA
30474
US

IV. Provider business mailing address

210 E. DERENNE AVE.
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-386-1212
  • Fax: 912-535-9779
Mailing address:
  • Phone: 912-644-5353
  • Fax: 912-644-5282

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: JOHN M BUTLER
Title or Position: CEO
Credential:
Phone: 912-644-5300