Provider Demographics
NPI:1548420599
Name:SPAHOS, REBECCA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:SPAHOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:M
Other - Last Name:FABBRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1058 BERMUDA RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0858
Mailing Address - Country:US
Mailing Address - Phone:912-871-7100
Mailing Address - Fax:912-871-7110
Practice Address - Street 1:1058 BERMUDA RUN ROAD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0858
Practice Address - Country:US
Practice Address - Phone:912-871-7100
Practice Address - Fax:912-871-7110
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA69188208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137844AMedicaid