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SPECTRUM PEDIATRIC GRP
NPI 1154447043
Clinic/Center - Medical Specialty in Kennesaw, GA

Active since March 22, 2007CLIA 11D1043994 · Waiver
3104 CREEKSIDE VILLAGE DR, SUITE 504, KENNESAW, GA 30144(770) 966-0778 Get Directions Write a Review

NPPES record last updated: May 19, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Spectrum Pediatric Grp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SPECTRUM PEDIATRIC GRP (NPI 1154447043) is a healthcare organization registered as a medical specialty in Kennesaw, Georgia and active in the NPI registry since March 2007. The organization holds a CLIA Waiver certificate valid through August 8, 2027 and lists Kola Ologunja, President, as its authorized official.

NPPES Registry Identity

NPI1154447043
Entity TypeOrganization
Primary Taxonomy261QM2500X
Legal Business NameSPECTRUM PEDIATRIC GRP
Location Address3104 CREEKSIDE VILLAGE DR, SUITE 504Kennesaw, GA 30144
Mailing Address3104 Creekside Village Dr, Suite 504Kennesaw, GA 30144
Phone(770) 966-0778
Organization SubpartNo
Authorized OfficialKola OlogunjaPresident · (770) 966-0778
Enumeration DateMarch 22, 2007
Last NPPES UpdateMay 19, 2008
✔ NPI 1154447043 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Medical SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM2500X
License✔ Licensed in GA · 050548
Definition
An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
3104 CREEKSIDE VILLAGE DR, Kennesaw, GA 30144
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Other Identifiers 2

Other855356GA · Blue Cross Blue Shield
Medicaid000972408GGA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D1043994

Spectrum Pediatric Group · Kennesaw, GA
Active · expires Aug 8, 2027
CLIA Number11D1043994
Laboratory TypePhysician Office
Certificate Effective DateAugust 9, 2025
Certificate Expiration DateAugust 8, 2027
Laboratory DirectorKola Ologunja
Laboratory Phone(770) 966-0778
Laboratory LocationSpectrum Pediatric Group3150 Cobb Parkway, Suite 130, Kennesaw, GA 30152
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Spectrum Pediatric Grp's NPI number?

The NPI number for Spectrum Pediatric Grp is 1154447043. It was assigned to this organization in the NPPES registry on March 22, 2007.

Where is Spectrum Pediatric Grp located?

Spectrum Pediatric Grp is located at 3104 Creekside Village Dr Suite 504, Kennesaw, GA 30144. The listed phone number is (770) 966-0778.

What is Spectrum Pediatric Grp's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Medical Specialty, with taxonomy code 261QM2500X.

Does Spectrum Pediatric Grp hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D1043994) is associated with this NPI, valid through August 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Spectrum Pediatric Grp was last updated on May 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.