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General NPI Number Information
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NPI Number | 1013696756
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Entity Type | Organization
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Legal Business Name | OPTIMAL LONGEVITY LLC
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 1300 PEACHTREE INDUSTRIAL BLVD STE 1201
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City | SUWANEE
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State | GA
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Zip | 30024-4550
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Country | US
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Telephone | 678-614-9848
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 HOLCOMB BRIDGE RD STE 226
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City | NORCROSS
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State | GA
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Zip | 30092-5405
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Country | US
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Telephone | 678-614-9848
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAHN SAMANTHA CHUI
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Credential |
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Telephone | 770-451-7996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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