Provider Demographics
NPI:1437381415
Name:SPILKER MEDICAL, LLC
Entity Type:Organization
Organization Name:SPILKER MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:SPILKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-590-1440
Mailing Address - Street 1:1690 STONE VILLAGE LANE NW
Mailing Address - Street 2:SUITE 921
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7714
Mailing Address - Country:US
Mailing Address - Phone:770-590-1440
Mailing Address - Fax:770-792-9231
Practice Address - Street 1:1690 STONE VILLAGE LANE NW
Practice Address - Street 2:SUITE 921
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7714
Practice Address - Country:US
Practice Address - Phone:770-590-1440
Practice Address - Fax:770-792-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-10
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031133261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
C89514OtherUPIN
GA202G701676OtherMEDICARE PTAN
08BBSQJMedicare UPIN