Organization
OPTIMA THERAPY SERVICES CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSHUA E. STEFANOFF (CFO)
(678) 936-3535
Entity
Organization
Contact information
Practice address
621 WASHINGTON ST SW, SUITE B1, GAINESVILLE, GA 30501-8567
(678) 936-3535
Mailing address
790 PARK ST, GAINESVILLE, GA 30501-3417
(678) 936-3535
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OT004965
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
896763088F
—
GA
Enumeration date
07/07/2015
Last updated
07/07/2015
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