Healthcare Provider Details

I. General information

NPI: 1568925329
Provider Name (Legal Business Name): OPTIMUM MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 06/08/2025
Certification Date: 06/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10044 HIGHWAY 46
BON AQUA TN
37025-1764
US

IV. Provider business mailing address

10044 HIGHWAY 46
BON AQUA TN
37025-1764
US

V. Phone/Fax

Practice location:
  • Phone: 931-996-4247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER SHEA BURRESS
Title or Position: OWNER
Credential: DO
Phone: 615-996-4247