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General NPI Number Information
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NPI Number | 1902566557
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Entity Type | Organization
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Legal Business Name | OPTIMAL PLAN NUTRITION, LLC.
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 145 GOVERNORS SQ STE A
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-4861
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Country | US
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Telephone | 404-509-1195
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Fax |
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Provider Business Mailing Address
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Address Line | 947 SALISBURY TRL
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City | RIVERDALE
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State | GA
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Zip | 30296-1549
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Country | US
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Telephone | 404-509-1195
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY LAFORTUNE
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Credential | MS, RDN
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Telephone | 404-509-1195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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