KALEIDOSCOPE PEDIATRICS PC (NPI# 1407045495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407045495 |
| Entity Type | Organization |
| Organization Name | KALEIDOSCOPE PEDIATRICS PC |
| Practice Address |
1523 Johnson Ferry Rd Suite 150 Marietta GA 30062-6438 |
| Practice Telephone | 7705091234 |
| Mailing Telephone | 7705091234 |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2007-10-16 |
| Authorized Official Name | SUSAN GAIL STAVISS (PRESIDENT) |
| Authorized Official Telephone | 7705091234 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | BLUE CROSS BLUE SHIELD | 52478249004 | 01 |
| Street Address |
1523 JOHNSON FERRY RD SUITE 150 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30062-6438 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235128455 | Whitney S Denton | Family Medicine | 1523 Johnson Ferry Rd, Suite 150, Marietta, GA 30062-9114 | 2005-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578051 | Pamela D Kretzmer | Social Worker | 3855 Shallowford Road, Suite 420, Marietta, GA 30062 | 2020-11-03 |
| 1932714680 | Michelle Chambless | Physical Therapist | Team Rehabilitation Ga01, LLC, 1401 Johnson Ferry Road, Suite 340, Marietta, GA 30062 | 2020-09-10 |
| 1700408887 | Life University | Chiropractor | 1323 Roswell Road, Marietta, GA 30062 | 2020-05-12 |
| 1104451160 | Sno Healthcare Group | Clinic/Center | 2424 Roswell Rd Ste 120, Marietta, GA 30062 | 2020-03-10 |
| 1811536212 | Sandy Plains Dental Group, PC | Dentist | 3460 Sandy Plains Rd, Suite 240, Marietta, GA 30062 | 2020-01-02 |
| 1073159034 | Magdala Tulcie Jodesty-jackson | Social Worker | 4343 Shalloword Road, Building H, Suite 4 Lower Level, Marietta, GA 30062 | 2019-11-25 |
| 1598235178 | Matthew Driggers | Counselor | 4343 Shallowford Rd C2, Marietta, GA 30062 | 2018-11-27 |
| 1750895785 | Emily Grace Minday | Counselor | 4343 Shallowford Road Building C, Suite 1 Lower Level, Marietta, GA 30062 | 2017-11-29 |
| 1477072122 | Jason Lee Amos | Speech-Language Pathologist | 3660 Chestnut Ridge Court, Marietta, GA 30062 | 2017-09-13 |
| 1346761376 | Marian Pomaah Opoku-agyeman | Nurse Practitioner | 4661 Andrea Pointe, Marietta, GA 30062 | 2017-06-29 |
| Find all providers in zip 30062 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679523443 | Craig L Lebish | Pediatrics | 3405 Dallas Hwy Sw Ste 300, Marietta, GA 30064-6426 | 2006-05-11 |
| 1346242229 | Susan Gail Staviss | Pediatrics | 3939 Roswell Rd, Suite 300, Marietta, GA 30062-6251 | 2005-08-11 |
| 1386078152 | Cobb Pediatrics | Pediatrics | 3405 Dallas Hwy Sw, Suite 300, Marietta, GA 30064-6425 | 2013-08-28 |
| 1154687721 | Tina Kim Vothang | Pediatrics | 3747 Roswell Rd, Suite 201, Marietta, GA 30062-6215 | 2012-04-08 |
| 1265759229 | Anna Chandler Schulenborg | Pediatrics | 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062-8620 | 2010-04-29 |
| 1922268838 | Pediatric and Adolescent Healthcare,pc | Pediatrics | 1163 Johnson Ferry Rd, Suite 170, Marietta, GA 30068-2764 | 2008-06-13 |
| 1841337896 | East Cobb Pediatrics and Adolescent Medicine, PC | Pediatrics | 1121 Johnson Ferry Rd, Suite 220, Marietta, GA 30068-5425 | 2007-01-31 |
| 1962550467 | Dara Hosch | Pediatrics | 3405 Dallas Hwy Sw Ste 300, Marietta, GA 30064-6426 | 2007-01-08 |
| 1558428193 | Tamara Nix | Pediatrics | 2155 Post Oak Tritt Rd, Suite 100, Marietta, GA 30062-8620 | 2007-01-02 |
| 1538240353 | Erika Sandra Van Putten | Pediatrics | 3405 Dallas Hwy Sw Ste 300, Marietta, GA 30064-6426 | 2006-10-18 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.