| Spectrum Internal Medicine, Llc | |
|
401 S Main St Suite B3 Alpharetta GA 30009-1974 | |
| (678) 319-9901 | |
| (678) 319-9902 |
| Full Name | Spectrum Internal Medicine, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 401 S Main St, Alpharetta, Georgia |
| Authorized Official Name and Position | Julius Kolawole Adebisi (MEDICAL DIRECTOR) |
| Authorized Official Contact | 6783199901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectrum Internal Medicine, Llc 401 S Main St Suite B3 Alpharetta GA 30009-1974 Ph: (678) 319-9901 | Spectrum Internal Medicine, Llc 401 S Main St Suite B3 Alpharetta GA 30009-1974 Ph: (678) 319-9901 |
| NPI Number | 1437576659 |
|---|---|
| Provider Enumeration Date | 03/26/2014 |
| Last Update Date | 03/26/2014 |
| Medicare PECOS PAC ID | 4688895741 |
|---|---|
| Medicare Enrollment ID | O20141015000971 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437576659 | NPI | - | NPPES |
| 390122159B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 58939 (Georgia) | Primary |
| Provider Name | Julius K Adebisi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730127713 PECOS PAC ID: 7214033596 Enrollment ID: I20070926000560 |
| Provider Name | Eunice Momeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457724874 PECOS PAC ID: 3678820842 Enrollment ID: I20180718003467 |
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