Healthcare Provider Details

I. General information

NPI: 1417723545
Provider Name (Legal Business Name): OPTIMUM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 WALKER LN STE 350
ALEXANDRIA VA
22310-3256
US

IV. Provider business mailing address

6354 WALKER LN STE 350
ALEXANDRIA VA
22310-3256
US

V. Phone/Fax

Practice location:
  • Phone: 256-425-4050
  • Fax:
Mailing address:
  • Phone: 256-425-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLISON PAIGE GABBERT
Title or Position: CEO
Credential: NP
Phone: 256-425-4050