Optima Therapy Services Corp.

Primary specialty

SpecialistTaxonomy code 174400000X

License

OT004965 Issued in GA

Legal business name

OPTIMA THERAPY SERVICES CORP.

Practice address

621 Washington St SW
Suite B1
Gainesville, GA 30501-8567

Phone

(678) 936-3535

NPI assigned

Jul 7, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Joshua E. Stefanoff

Title

Cfo

Phone

(678) 936-3535

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1436227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436227200000",
    "number": "1962885111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 PARK ST",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013417",
            "telephone_number": "678-936-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 WASHINGTON ST SW",
            "address_2": "SUITE B1",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305018567",
            "telephone_number": "678-936-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMA THERAPY SERVICES CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-07",
        "last_updated": "2015-07-07",
        "status": "A",
        "authorized_official_last_name": "STEFANOFF",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "678-936-3535",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "OT004965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "896763088F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.