Provider Demographics
NPI:1881028082
Name:SPEER, BRENT JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:JOSEPH
Last Name:SPEER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3193 HOWELL MILL RD NW STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2129
Mailing Address - Country:US
Mailing Address - Phone:404-351-1131
Mailing Address - Fax:
Practice Address - Street 1:3193 HOWELL MILL RD NW STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2129
Practice Address - Country:US
Practice Address - Phone:404-351-1131
Practice Address - Fax:404-351-3515
Is Sole Proprietor?:No
Enumeration Date:2013-08-25
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL36867208000000X
GA78294208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics