MEDICARE: OPTIM ORTHOPEDICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1730573841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIM ORTHOPEDICS, LLC

Provider Business Mailing Address
First Line	:	210 E DERENNE AVE
Second Line	:	ATTN.: PROVIDER ENROLLMENT
City	:	SAVANNAH
State	:	GA
Zip	:	31405-6736
Country	:	US
Telephone Number	:	912-644-5300
Fax Number	:	912-644-5260

Provider Business Practice Location Address
First Line	:	810 TOWNE PARK DR STE 200
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-5167
Country	:	US
Telephone Number	:	912-826-2533
Fax Number	:	912-826-2572

Authorized Official
Title or Position	:	CEO
Name	:	MIKE BUTLER
Credential	:
Telephone Number	:	912-644-5300

Provider Enumeration Date	:	03/26/2015
Last Update Date	:	01/18/2019

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