Provider Demographics
NPI:1790030096
Name:SPENCE-ROBERTS, MARISHA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARISHA
Middle Name:
Last Name:SPENCE-ROBERTS
Suffix:
Gender:F
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:868 YORK AVE SW
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH DEKALB, LLC
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2750
Mailing Address - Country:US
Mailing Address - Phone:404-752-1400
Mailing Address - Fax:
Practice Address - Street 1:2124 CANDLER ROAD
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER SOUTH DEKALB, LLC
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-5500
Practice Address - Country:US
Practice Address - Phone:404-836-0272
Practice Address - Fax:404-420-2445
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2016-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAOPT002698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist