Provider Demographics
NPI:1619979325
Name:SPECTOR, JAY ERIN (DPM)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:ERIN
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 MEDLOCK BRIDGE RD STE 126
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4408
Mailing Address - Country:US
Mailing Address - Phone:770-614-0003
Mailing Address - Fax:770-614-9294
Practice Address - Street 1:9700 MEDLOCK BRIDGE RD STE 126
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4408
Practice Address - Country:US
Practice Address - Phone:404-614-0003
Practice Address - Fax:770-614-9294
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000715213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU47416Medicare UPIN
GRP71Medicare ID - Type Unspecified