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General NPI Number Information
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NPI Number | 1437576659
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Entity Type | Organization
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Legal Business Name | SPECTRUM INTERNAL MEDICINE, LLC
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 401 S MAIN ST SUITE B3
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City | ALPHARETTA
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State | GA
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Zip | 30009-1974
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Country | US
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Telephone | 678-319-9901
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Fax | 678-319-9902
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Provider Business Mailing Address
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Address Line | 401 S MAIN ST SUITE B3
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City | ALPHARETTA
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State | GA
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Zip | 30009-1974
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Country | US
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Telephone | 678-319-9901
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Fax | 678-319-9902
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JULIUS KOLAWOLE ADEBISI
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Credential | M.D
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Telephone | 678-319-9901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 58939
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License Number State | GA
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