Provider Demographics
NPI:1689326266
Name:SPOONER, CATHERINE VENISA
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:VENISA
Last Name:SPOONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SUGARLOAF PKWY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4855
Mailing Address - Country:US
Mailing Address - Phone:678-322-7325
Mailing Address - Fax:
Practice Address - Street 1:302 SUGARLOAF PKWY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4855
Practice Address - Country:US
Practice Address - Phone:954-815-3788
Practice Address - Fax:800-252-4710
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP011430251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care