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General NPI Number Information
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NPI Number | 1568925329
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL GROUP
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 10044 HIGHWAY 46
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City | BON AQUA
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State | TN
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Zip | 37025-1764
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Country | US
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Telephone | 931-996-4247
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Fax |
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Provider Business Mailing Address
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Address Line | 10044 HIGHWAY 46
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City | BON AQUA
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State | TN
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Zip | 37025-1764
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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 | OWNER
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Name | CHRISTOPHER SHEA BURRESS
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Credential | DO
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Telephone | 615-996-4247
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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