Healthcare Provider Details

I. General information

NPI: 1972566883
Provider Name (Legal Business Name): PHILIP ROBERT SPANDORFER MD, MSCE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1902 DENTON WALK CT
MARIETTA GA
30062-8158
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number055977
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number055977
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: