Optiwell MD Duluth LLC

Primary specialty

Dietary ManagerTaxonomy code 132700000X

License

61722 Issued in GA

Legal business name

OPTIWELL MD DULUTH LLC

Practice address

4300 Pleasant Hill Rd
Suite a
Duluth, GA 30096-6379

Phone

(678) 682-8734

Fax

(678) 682-8736

NPI assigned

Jul 1, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Bell Federico

Title

Owner

Phone

(404) 202-9433

Specialties & licenses 1

Addresses

Other names 1

• OptiWell MD Other name

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1285017889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8770 COLONIAL PL",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300976641",
            "telephone_number": "404-202-9433",
            "fax_number": "800-845-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 PLEASANT HILL RD",
            "address_2": "SUITE A",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966379",
            "telephone_number": "678-682-8734",
            "fax_number": "678-682-8736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIWELL MD DULUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "FEDERICO",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "BELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-202-9433",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "132700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietary Manager",
            "state": "GA",
            "license": "61722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OptiWell MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Dietary Manager in Duluth, GA
• Providers in Duluth, GA by specialty
• Dietary Manager in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.