Organization Active NPI

Optimal Integrative Care, LLC

  • Infectious Disease Physician
  • Atlanta, GA
National Provider Identifier
1962187690
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
OPTIMAL INTEGRATIVE CARE, LLC
Practice address
3193 Howell Mill Rd NW Ste 125
Atlanta, GA 30327-2100
Phone
(404) 352-1223
Fax
(404) 352-1226
NPI assigned
Jun 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Authorized official

Name
Sharon Page Dickerson
Title
Vice President
Phone
(404) 352-1223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

3193 Howell Mill Rd NW Ste 125
Atlanta, GA 30327-2100

Mailing address

PO Box 550428
Atlanta, GA 30355-2928
Phone (404) 352-1223

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240308001890 GA Part B Supplier - Clinic/Group Practice 2163868456 Receives reassigned benefits from 2 practitioners
Practice locations: Atlanta, GA

National Provider Directory

National Provider Directory

Locations

3193 Howell Mill Rd NW
Ste 125
Atlanta, GA 30327
Phone (404) 352-1223

3193 Howell Mill Rd NW
Ste 204
Atlanta, GA 30327
Phone (404) 352-1223

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1962187690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 550428",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303552928",
            "telephone_number": "404-352-1223",
            "fax_number": "404-352-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3193 HOWELL MILL RD NW STE 125",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303272100",
            "telephone_number": "404-352-1223",
            "fax_number": "404-352-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMAL INTEGRATIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "DICKERSON",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "PAGE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "404-352-1223"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.