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General NPI Number Information
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NPI Number | 1174859268
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Entity Type | Organization
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Legal Business Name | OPTIMAL CHOICE GROUP INC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 15105 JOHN J DELANEY DR SUITE D 29
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City | CHARLOTTE
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State | NC
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Zip | 28277-2847
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Country | US
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Telephone | 704-756-1963
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Fax |
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Provider Business Mailing Address
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Address Line | 15105 JOHN J DELANEY DR SUITE D 29
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City | CHARLOTTE
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State | NC
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Zip | 28277-2847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY W FURMAN
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Credential |
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Telephone | 704-756-1963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 24156
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License Number State | NC
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