Provider Demographics
NPI:1386723310
Name:SPENCER, DENNIS
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:803 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-1211
Mailing Address - Country:US
Mailing Address - Phone:706-453-1201
Mailing Address - Fax:706-999-3221
Practice Address - Street 1:803 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-1211
Practice Address - Country:US
Practice Address - Phone:706-453-1201
Practice Address - Fax:706-999-3221
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047663207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH26987Medicare UPIN
GA16BBDHMMedicare PIN