11D2144678 CLIA NUMBER - OPTIMAL PERFORMANCE MEDICINE, LLC

Laboratory Demographics

CLIA Number: 11D2144678

Facility Name: OPTIMAL PERFORMANCE MEDICINE, LLC

Facility Address:
120 STONEBRIDGE PARKWAY, SUITE 430
WOODSTOCK, GA
ZIP 30189
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Facility Phone Number: 678 205-0700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1346755386

Taxonomy: 207R00000X - Internal Medicine
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

CLIA Record

Field Name	Field Value
CLIA Number	11D2144678
LAB Type	Physician Office
Facility Name	OPTIMAL PERFORMANCE MEDICINE, LLC
Street	120 STONEBRIDGE PARKWAY, SUITE 430
City	WOODSTOCK
State	GA
ZIP	30189
Phone	678 205-0700
CertificateType	4
CertificateEffectiveDate	2/21/2024
CertificateExpirationDate	2/20/2026
FacilityType	Waiver

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This page was last updated on: 4/23/2024