Provider Demographics
NPI:1508424045
Name:SPENCER, L. LYNN
Entity Type:Individual
Prefix:
First Name:L. LYNN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LATOYA
Other - Middle Name:LYNETTE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:REDAN
Mailing Address - State:GA
Mailing Address - Zip Code:30074-0044
Mailing Address - Country:US
Mailing Address - Phone:678-744-3926
Mailing Address - Fax:470-274-3589
Practice Address - Street 1:6157 SAINT CHRISTOPHERS CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-7964
Practice Address - Country:US
Practice Address - Phone:400-576-8335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEG