Provider Demographics
NPI:1841589900
Name:SPENCER, RACQUEL DIONNESIA (MD)
Entity Type:Individual
Prefix:
First Name:RACQUEL
Middle Name:DIONNESIA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 KIRBY RD STE 14
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8207
Practice Address - Country:US
Practice Address - Phone:901-289-3684
Practice Address - Fax:901-754-3333
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2022-11-23
Deactivation Date:2022-11-10
Deactivation Code:
Reactivation Date:2022-11-18
Provider Licenses
StateLicense IDTaxonomies
TN50264207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine