Organization Active NPI

Optimal Health Care, LLC

  • Internal Medicine Physician
  • Marietta, GA
National Provider Identifier
1255776134
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
041094 Issued in GA
Legal business name
OPTIMAL HEALTH CARE, LLC
Practice address
1121 Johnson Ferry Rd
Suite 205
Marietta, GA 30068-5425
Phone
(770) 485-3837
Fax
(470) 377-4468
NPI assigned
May 6, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sidney Paul Chastang, M.D.NPI 1720077225
Title
Manager
Phone
(770) 485-3837

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 041094 GA Primary

Addresses

Primary practice location

1121 Johnson Ferry Rd
Suite 205
Marietta, GA 30068-5425

Mailing address

1121 Johnson Ferry Rd
Suite 205
Marietta, GA 30068-5425
Phone (770) 485-3837

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130626000847 GA Part B Supplier - Clinic/Group Practice 7719126556 Receives reassigned benefits from 1 practitioner
Practice locations: Marietta, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2073332Optimal Health Care, LLC1121 Johnson Ferry Road, Suite 205, Marietta, GA 30068Certificate of waiverFeb 16, 2028

National Provider Directory

National Provider Directory

Locations

1121 Johnson Ferry Rd
Ste 205
Marietta, GA 30068
Phone (770) 485-3837

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20066/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744761600000",
    "number": "1255776134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 JOHNSON FERRY RD",
            "address_2": "SUITE 205",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300685425",
            "telephone_number": "770-485-3837",
            "fax_number": "470-377-4468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 JOHNSON FERRY RD",
            "address_2": "SUITE 205",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300685425",
            "telephone_number": "770-485-3837",
            "fax_number": "470-377-4468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL HEALTH CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-06",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A",
        "authorized_official_last_name": "CHASTANG",
        "authorized_official_first_name": "SIDNEY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "770-485-3837",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "041094",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.