Provider Demographics
NPI:1992202121
Name:SPEIR, ETHAN JESSE (MD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:JESSE
Last Name:SPEIR
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 1:1521 MCGILL PARK AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4203
Mailing Address - Country:US
Mailing Address - Phone:770-601-5517
Mailing Address - Fax:
Practice Address - Street 1:201 DOWMAN DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1007
Practice Address - Country:US
Practice Address - Phone:404-727-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program