Provider Demographics
NPI:1902566557
Name:OPTIMAL PLAN NUTRITION, LLC.
Entity Type:Organization
Organization Name:OPTIMAL PLAN NUTRITION, LLC.
Other - Org Name:GREG'S OPTIMIZED NUTRITION, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFORTUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:404-509-1195
Mailing Address - Street 1:947 SALISBURY TRL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1549
Mailing Address - Country:US
Mailing Address - Phone:404-509-1195
Mailing Address - Fax:
Practice Address - Street 1:145 GOVERNORS SQ STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4861
Practice Address - Country:US
Practice Address - Phone:404-509-1195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty