Provider Demographics
NPI:1558748244
Name:SPENCER FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:SPENCER FAMILY MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-607-9032
Mailing Address - Street 1:650 HENDERSON DRIVE, SUITE 504
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3744
Mailing Address - Country:US
Mailing Address - Phone:770-607-9032
Mailing Address - Fax:770-607-9035
Practice Address - Street 1:650 HENDERSON DR STE 504
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3760
Practice Address - Country:US
Practice Address - Phone:770-607-9032
Practice Address - Fax:770-607-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1558748244OtherEIN