Organization
KALEIDOSCOPE PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN GAIL STAVISS MD (PRESIDENT)
(770) 509-1234
Entity
Organization
Contact information
Practice address
1523 JOHNSON FERRY RD, SUITE 150, MARIETTA, GA 30062-6438
(770) 509-1234
Mailing address
1523 JOHNSON FERRY RD, SUITE 150, MARIETTA, GA 30062-6438
(770) 509-1234
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52478249004
BLUE CROSS BLUE SHIELD
GA
Enumeration date
10/16/2007
Last updated
10/16/2007
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us