Provider Demographics
NPI:1982139176
Name:ANDERSON, SPENCER ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:ROBERT
Last Name:ANDERSON
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 1:2522 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5640
Mailing Address - Country:US
Mailing Address - Phone:706-322-9313
Mailing Address - Fax:
Practice Address - Street 1:2522 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5640
Practice Address - Country:US
Practice Address - Phone:706-322-9313
Practice Address - Fax:706-322-9314
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA95455208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program