Provider Demographics
NPI:1750556965
Name:BROWN-SPENCER, CORRETTA STEPHANIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CORRETTA
Middle Name:STEPHANIE
Last Name:BROWN-SPENCER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 AUDREY WAY
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2147
Mailing Address - Country:US
Mailing Address - Phone:478-988-4787
Mailing Address - Fax:478-987-5376
Practice Address - Street 1:3285 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-2342
Practice Address - Country:US
Practice Address - Phone:478-784-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist