Healthcare Provider Details

I. General information

NPI: 1265603633
Provider Name (Legal Business Name): SPENCER I KOZINN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW SUITE 500
ATLANTA GA
30318-2538
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW SUITE 500
ATLANTA GA
30318-2538
US

V. Phone/Fax

Practice location:
  • Phone: 404-240-9700
  • Fax: 404-240-9701
Mailing address:
  • Phone: 404-240-9700
  • Fax: 404-240-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number232755
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number071836
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: