Provider Demographics
NPI:1841464609
Name:SPENCER, APRIL LATRICE (MD)
Entity type:Individual
Prefix:DR
First Name:APRIL
Middle Name:LATRICE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:APRIL
Other - Middle Name:LATRICE
Other - Last Name:SPEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 53398
Mailing Address - Street 2:JUST BREAST, LLC
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-1398
Mailing Address - Country:US
Mailing Address - Phone:708-320-1465
Mailing Address - Fax:404-343-0888
Practice Address - Street 1:3280 HOWELL MILL RD NW STE 243
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4100
Practice Address - Country:US
Practice Address - Phone:678-210-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59206208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G700840OtherMEDICARE PTAN
GA2021917623Medicare PIN