Healthcare Provider Details

I. General information

NPI: 1669140281
Provider Name (Legal Business Name): NANETTE LOCOLE SPENCER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 HICKORY FLAT HWY
CANTON GA
30115-7237
US

IV. Provider business mailing address

3333 RIVERWOOD PKWY SE STE 250
ATLANTA GA
30339-3304
US

V. Phone/Fax

Practice location:
  • Phone: 770-268-4357
  • Fax: 470-251-6064
Mailing address:
  • Phone: 770-914-0016
  • Fax: 770-955-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN250345
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: