Provider Demographics
NPI:1033511209
Name:SPEARMAN, JEREMIAH JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:JOHN
Last Name:SPEARMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7042
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30502-0042
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:5612 ARDMORE CT
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-6375
Practice Address - Country:US
Practice Address - Phone:770-533-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007377363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant