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Spectrum Pediatric Grp
Medical Specialty Clinic/Center in Kennesaw, Georgia
NPI 1154447043

Spectrum Pediatric Grp is a Medical Specialty Clinic/Center based in Kennesaw, GA and is specialized in Medical Specialty. Spectrum Pediatric Grp practices in Kennesaw, GA. The NPI Number for Spectrum Pediatric Grp is 1154447043 and holds a License No. 050548 (Georgia).

The current practice location address for Spectrum Pediatric Grp is 3104 Creekside Village Dr, Kennesaw, GA and can be reached out via phone at 770-966-0778.

Location: 3104 Creekside Village Dr, Kennesaw, GA, 30144
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1154447043
Provider Name
Spectrum Pediatric Grp
Credential
Provider Entity Type
Organization
Address
3104 Creekside Village Dr, Kennesaw, GA, 30144
Phone Number
770-966-0778
Fax Number
Provider Enumeration Date
03/22/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
855356 01 GA BLUE CROSS BLUE SHIELD
000972408G 05 GA
institution
Provider Business Practice Location Address Details
Address
3104 Creekside Village Dr
City
Kennesaw
State
Georgia
Zip
30144
Phone Number
770-966-0778
Fax Number
person
Provider Business Mailing Address Details
Address
3104 Creekside Village Dr
City
Kennesaw
State
Georgia
Zip
30144
Phone Number
770-966-0778
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Medical Specialty
Taxonomy
261QM2500X
License No.
050548 (Georgia)
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
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