Basic Information
| Provider Information | |||||||||
| NPI: | 1285186866 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPTION 1 NUTRITION SOLUTIONS LLC | ||||||||
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| OtherOrganizationName: | AVEANNA HEALTHCARE MEDICAL SOLUTIONS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 INTERSTATE NORTH PKWY SE STE 1600 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303395047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702488740 | ||||||||
| FaxNumber: | 7702488192 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 W 25TH ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286582852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668831188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2016 | ||||||||
| LastUpdateDate: | 11/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | WHITESIDE | ||||||||
| AuthorizedOfficialFirstName: | VICKI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR REGULATORY LICENSING | ||||||||
| AuthorizedOfficialTelephone: | 7702488740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.