Provider Demographics
NPI:1164576112
Name:MISNER, SPENCER CARLTON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:CARLTON
Last Name:MISNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 BROADRICK DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-226-1130
Mailing Address - Fax:706-272-7043
Practice Address - Street 1:1432 BROADRICK DRIVE
Practice Address - Street 2:DALTON FOOT AND ANKLE SURGERY CENTER
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-226-1130
Practice Address - Fax:706-272-7043
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000449213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U21425Medicare UPIN