Healthcare Provider Details

I. General information

NPI: 1629461405
Provider Name (Legal Business Name): SPECTRUM ANALYTIC CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HAMMOND DR NE BLDG 16 STE 100
ATLANTA GA
30328-6144
US

IV. Provider business mailing address

PO BOX 76094
ATLANTA GA
30358
US

V. Phone/Fax

Practice location:
  • Phone: 678-974-2162
  • Fax: 888-533-9896
Mailing address:
  • Phone: 678-974-2162
  • Fax: 888-533-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN BUSH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 678-974-2162