MEDICARE: SPELIOS AND ASSOCIATES- SUMMITT PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1447483730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPELIOS AND ASSOCIATES- SUMMITT PC

Provider Business Mailing Address
First Line	:	3823 ROSWELL RD
Second Line	:	SUITE 205
City	:	MARIETTA
State	:	GA
Zip	:	30062-6278
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3823 ROSWELL RD
Second Line	:	SUITE 205
City	:	MARIETTA
State	:	GA
Zip	:	30062-6278
Country	:	US
Telephone Number	:	770-973-9275
Fax Number	:	770-973-1915

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	DONALD WALKER DEHAVEN
Credential	:
Telephone Number	:	678-879-1177

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	09/02/2009

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