Healthcare Provider Details

I. General information

NPI: 1831023969
Provider Name (Legal Business Name): SPECTRUM HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 UPPER RIVERDALE RD SW STE 155
RIVERDALE GA
30274-2632
US

IV. Provider business mailing address

PO BOX 3505
PEACHTREE CITY GA
30269-7505
US

V. Phone/Fax

Practice location:
  • Phone: 678-464-3078
  • Fax:
Mailing address:
  • Phone: 678-464-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHNNY BROWN
Title or Position: OWNER
Credential:
Phone: 678-464-3078