Provider Demographics
NPI:1720196249
Name:SPEKTOR, IRENA (MD)
Entity Type:Individual
Prefix:
First Name:IRENA
Middle Name:
Last Name:SPEKTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENA
Other - Middle Name:
Other - Last Name:SPEVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1796
Mailing Address - Country:US
Mailing Address - Phone:404-364-7000
Mailing Address - Fax:
Practice Address - Street 1:2525 CUMBERLAND PARKWAY
Practice Address - Street 2:KAISER PERMANENTE CUMBERLAND MEDICAL CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339
Practice Address - Country:US
Practice Address - Phone:770-431-4330
Practice Address - Fax:770-431-4193
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053611207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA610670993AMedicaid
GAI13118Medicare UPIN
07BBSBKMedicare ID - Type Unspecified
GA610670993AMedicaid