Spectrum Pediatric GRP

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

050548 Issued in GA

Legal business name

SPECTRUM PEDIATRIC GRP

Practice address

3104 Creekside Village Dr
Suite 504
Kennesaw, GA 30144

Phone

(770) 966-0778

NPI assigned

Mar 22, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kola Ologunja, MDNPI 1649270158

Title

President

Phone

(770) 966-0778

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kola Ologunja

  • Pediatrics Physician
  • Kennesaw, GA
  • NPI 1649270158
  NPD (past) Authorized official
• Alison G. Ball, M.D.

  • Pediatrics Physician
  • Marietta, GA
  • NPI 1104125764
  NPD (past)
• Jennie Barbara Sharp, NP

  • Pediatric Nurse Practitioner
  • Kennesaw, GA
  • NPI 1851706972
  NPD (past)
• Kevin Sullivan

  • Pediatrics Physician
  • Kennesaw, GA
  • NPI 1003497801
  NPD (past)
• Lum Frundi, MD

  • Pediatrics Physician
  • York, PA
  • NPI 1649685728
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1154447043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3104 CREEKSIDE VILLAGE DR",
            "address_2": "SUITE 504",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3104 CREEKSIDE VILLAGE DR",
            "address_2": "SUITE 504",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30144",
            "telephone_number": "770-966-0778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM PEDIATRIC GRP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "OLOGUNJA",
        "authorized_official_first_name": "KOLA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-966-0778",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "050548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "855356",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000972408G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cha'Ke'Sha Spencer, LPC
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• Medical Specialty Clinic/Center in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Medical Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.