Kaleidoscope Pediatrics Pc

LBN: Kaleidoscope Pediatrics Pc
Kaleidoscope Pediatrics Pc is an health care organization with primary practice located at 1523 Johnson Ferry Rd Suite 150, Marietta GA 30062-6438. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Adolescent Medicine, which is considered as the primary health care specialty. Kaleidoscope Pediatrics Pc can be contacted via phone (770) 509-1234, or through Staviss, Susan Gail via phone (770) 509-1234.

Contact Information

Primary practice address
1523 Johnson Ferry Rd Suite 150 Marietta GA 30062-6438
Phone: (770) 509-1234
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Staviss, Susan Gail Doctor of Medicine (MD)
Phone: (770) 509-1234

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Adolescent Medicine 2080A0000X

Profile Details

NPI number 1407045495
LBN Legal business name Kaleidoscope Pediatrics Pc
DBA Doing business as
Authorized official Staviss, Susan Gail Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 16th, 2007
Last updated Oct 16th, 2007 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407045495 NPPES
Georgia Other 52478249004 BLUE CROSS BLUE SHIELD

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