Provider Demographics
NPI:1073607875
Name:SPECTRUM NEUROSURGICAL SPECIALISTS PC
Entity Type:Organization
Organization Name:SPECTRUM NEUROSURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:DISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-664-9600
Mailing Address - Street 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:STE 310
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:770-664-9600
Mailing Address - Fax:770-664-9856
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:STE 310
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-664-9600
Practice Address - Fax:770-664-9856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300025035EMedicaid
GA300025035EMedicaid
GAGRP741Medicare PIN