| Optimal Performance Medicine Llc | |
|
120 Stonebridge Pkwy Ste 430 Woodstock GA 30189-3769 | |
| (678) 250-0700 | |
| (678) 250-0701 |
| Full Name | Optimal Performance Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 120 Stonebridge Pkwy Ste 430, Woodstock, Georgia |
| Authorized Official Name and Position | Michael George Skardasis (PRACTICE OWNER) |
| Authorized Official Contact | 6782500700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimal Performance Medicine Llc 210 Brook Valley Dr Roswell GA 30075-2356 Ph: (770) 842-9405 | Optimal Performance Medicine Llc 120 Stonebridge Pkwy Ste 430 Woodstock GA 30189-3769 Ph: (678) 250-0700 |
| NPI Number | 1346755386 |
|---|---|
| Provider Enumeration Date | 12/13/2017 |
| Last Update Date | 12/13/2017 |
| Medicare PECOS PAC ID | 0345505053 |
|---|---|
| Medicare Enrollment ID | O20180530002433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346755386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael G Skardasis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740323468 PECOS PAC ID: 4688605405 Enrollment ID: I20050822001035 |
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