MEDICARE: OPTIMUM HEALTH REHAB OF HIRAM LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	111N00000X	Chiropractor
2	225100000X	Physical Therapist
3	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1982010732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMUM HEALTH REHAB OF HIRAM LLC

Provider Business Mailing Address
First Line	:	2133 HIGHWAY 317 STE 12-318
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-2649
Country	:	US
Telephone Number	:	678-730-6240
Fax Number	:	678-730-0280

Provider Business Practice Location Address
First Line	:	47 HIGHLAND PAVILION CT STE 102
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-4119
Country	:	US
Telephone Number	:	770-439-6997
Fax Number	:	770-439-0997

Authorized Official
Title or Position	:	OPERATIONS MGR
Name	:	MONICA SHELTON
Credential	:
Telephone Number	:	678-730-6240

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	04/11/2016

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