Provider Demographics
NPI:1437390101
Name:SPICER, WILLIAM TROY II (NP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:TROY
Last Name:SPICER
Suffix:II
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:907 18TH ST E STE 490
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3684
Mailing Address - Country:US
Mailing Address - Phone:229-391-3320
Mailing Address - Fax:229-391-3325
Practice Address - Street 1:907 18TH ST E STE 490
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3684
Practice Address - Country:US
Practice Address - Phone:229-391-3320
Practice Address - Fax:229-391-3325
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN066989363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAHOSP29Medicare PIN