Spectrum Internal Medicine, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

58939 Issued in GA

Legal business name

SPECTRUM INTERNAL MEDICINE, LLC

Practice address

401 S Main St
Suite B3
Alpharetta, GA 30009-1974

Phone

(678) 319-9901

Fax

(678) 319-9902

NPI assigned

Mar 26, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Julius Kolawole Adebisi, M.DNPI 1730127713

Title

Medical Director

Phone

(678) 319-9901

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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

• Julius Kolawole Adebisi, MD

  • Primary Care Clinic/Center
  • Alpharetta, GA
  • NPI 1730127713
  Medicare reassignment NPD Authorized official
• Eunice Momeh, NP-C

  • Family Nurse Practitioner
  • Alpharetta, GA
  • NPI 1457724874
  Medicare reassignment NPD
• Stephanie Regine Garba

  • Family Nurse Practitioner
  • Alpharetta, GA
  • NPI 1548869506
  NPD

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395792000000",
    "number": "1437576659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S MAIN ST",
            "address_2": "SUITE B3",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091974",
            "telephone_number": "678-319-9901",
            "fax_number": "678-319-9902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S MAIN ST",
            "address_2": "SUITE B3",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300091974",
            "telephone_number": "678-319-9901",
            "fax_number": "678-319-9902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-26",
        "last_updated": "2014-03-26",
        "status": "A",
        "authorized_official_last_name": "ADEBISI",
        "authorized_official_first_name": "JULIUS",
        "authorized_official_middle_name": "KOLAWOLE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "678-319-9901",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "58939",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "390122159B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Timothy Glenn Spence, O.D.
• Adam Andrew Spencer, BCBA

• Primary Care Clinic/Center in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.