Provider Demographics
NPI:1124034996
Name:SPENCE, JOHN V (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:V
Last Name:SPENCE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8852
Mailing Address - Country:US
Mailing Address - Phone:912-277-2077
Mailing Address - Fax:912-277-2080
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8852
Practice Address - Country:US
Practice Address - Phone:770-309-6636
Practice Address - Fax:912-277-2080
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-08-17
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Provider Licenses
StateLicense IDTaxonomies
GA55572207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA880364664AMedicaid
GA880364664AMedicaid
GA93BBJBVMedicare ID - Type UnspecifiedMEDICARE