Provider Demographics
NPI:1427557933
Name:SPICER, CAROL CHESSOR
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:CHESSOR
Last Name:SPICER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5108 STONE MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7468
Mailing Address - Country:US
Mailing Address - Phone:615-604-5865
Mailing Address - Fax:
Practice Address - Street 1:5531 EDMONDSON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5808
Practice Address - Country:US
Practice Address - Phone:615-834-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6517183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6517OtherTENNESSEE DEPARTMENT OF HEALTH