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General NPI Number Information
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NPI Number | 1255776134
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Entity Type | Organization
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Legal Business Name | OPTIMAL HEALTH CARE, LLC
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Dates
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Enumeration Date | 05/06/2013
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 1121 JOHNSON FERRY RD SUITE 205
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City | MARIETTA
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State | GA
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Zip | 30068-5425
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Country | US
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Telephone | 770-485-3837
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Fax | 470-377-4468
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Provider Business Mailing Address
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Address Line | 1121 JOHNSON FERRY RD SUITE 205
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City | MARIETTA
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State | GA
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Zip | 30068-5425
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Country | US
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Telephone | 770-485-3837
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Fax | 470-377-4468
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Authorized Official
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Title or Position | MANAGER
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Name | DR. SIDNEY PAUL CHASTANG
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Credential | M.D.
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Telephone | 770-485-3837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 041094
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License Number State | GA
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