Basic Information
| Provider Information | |||||||||
| NPI: | 1235449125 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTIMED HOSPITALISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2530 | ||||||||
| Address2: | |||||||||
| City: | DAVIDSON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280362530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049975525 | ||||||||
| FaxNumber: | 7049975531 | ||||||||
| Practice Location | |||||||||
| Address1: | 557 BROOKDALE DRIVE | ||||||||
| Address2: | |||||||||
| City: | STATESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286774107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048735661 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2010 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | AJJAN | ||||||||
| AuthorizedOfficialFirstName: | MAHDI | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7049975525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.