Provider Demographics
NPI:1962790881
Name:WILLIAMS, SPENCER
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5066 JEKYLL RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5066 JEKYLL RD
Practice Address - Street 2:241 PEACHTREE HILLS CR.
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-5224
Practice Address - Country:US
Practice Address - Phone:770-654-7905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant