Provider Demographics
NPI:1669050126
Name:SPAK, DAVID GEORGE
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:GEORGE
Last Name:SPAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3108
Mailing Address - Country:US
Mailing Address - Phone:888-291-4357
Mailing Address - Fax:931-490-1462
Practice Address - Street 1:801 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3108
Practice Address - Country:US
Practice Address - Phone:877-467-3123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist