Spirit of Key West LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

75152 Issued in GA

Legal business name

SPIRIT OF KEY WEST LLC

Doing business as

Lake Lanier Pediatrics
Suwanahoochee Pediatrics

Practice address

5629 Holiday Rd
Buford, GA 30518-1519

Phone

(678) 765-8622

Fax

(678) 765-8621

NPI assigned

Dec 5, 2016

Organization subpart

No

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

Authorized official

Name

Jana Renee Himmelbaum, DONPI 1427497353

Title

Owner

Phone

(678) 765-8622

Specialties & licenses 1

Addresses

Other names 2

• Lake Lanier Pediatrics Doing business as
• Suwanahoochee Pediatrics Doing business as

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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jana Renee Himmelbaum, D.O.

  • Pediatrics Physician
  • Buford, GA
  • NPI 1427497353
  Authorized official Same address or phone

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

{
    "created_epoch": "1480896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1881138279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5629 HOLIDAY RD",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181519",
            "telephone_number": "678-765-8622",
            "fax_number": "678-765-8621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5629 HOLIDAY RD",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181519",
            "telephone_number": "678-765-8622",
            "fax_number": "678-765-8621"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "110 Peachtree Industrial Blvd Ste A",
            "address_purpose": "LOCATION",
            "city": "Sugar Hill",
            "state": "GA",
            "postal_code": "305186288",
            "country_code": "US",
            "telephone_number": "678-765-8622",
            "fax_number": "678-765-8621",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPIRIT OF KEY WEST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-05",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "HIMMELBAUM",
        "authorized_official_first_name": "JANA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-765-8622",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "75152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Lanier Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Suwanahoochee Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nikiya S Spence, LCSW
• David P. Spielvogel, MD
• Regena G Spratling, CPNP-PC
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• Valerie Stallworth, LDO
• Kayla Alexis Stancea, APC
• Alexander Kim Steele, DC

• Primary Care Clinic/Center in Buford, GA
• Providers in Buford, 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 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.