Kaleidoscope Pediatrics PC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

KALEIDOSCOPE PEDIATRICS PC

Practice address

1523 Johnson Ferry Rd
Suite 150
Marietta, GA 30062-6438

Phone

(770) 509-1234

NPI assigned

Oct 16, 2007

Organization subpart

No

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

Authorized official

Name

Susan Gail Staviss, MD

Title

President

Phone

(770) 509-1234

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1407045495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 JOHNSON FERRY RD",
            "address_2": "SUITE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626438",
            "telephone_number": "770-509-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1523 JOHNSON FERRY RD",
            "address_2": "SUITE 150",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300626438",
            "telephone_number": "770-509-1234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALEIDOSCOPE PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-16",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "STAVISS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "GAIL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-509-1234",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52478249004",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Thomas Kaineg, M.D.
• Kaiser Foundation Health Plan of Georgia, Inc.
• Barbara A Kaiser, D.C. P.C.
• Meenakshi Hema Kakarala, MD
• Kaleidoscope Counseling LLC
• Candice Kalin, CCP
• Abigail Harrover Kalish, M.D.
• Louis B Kalish, MD
• Seibattu Kallon, NP
• Japna Kalra

• Pediatric Adolescent Medicine Physician in Marietta, GA
• Providers in Marietta, GA by specialty
• Pediatric Adolescent Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; 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.