Healthcare Provider Details

I. General information

NPI: 1700898285
Provider Name (Legal Business Name): ANNE-MARIE SPEARMAN P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5971 ROSIE LANE SE
MABLETON GA
30126
US

IV. Provider business mailing address

5971 ROSIE LN SE
MABLETON GA
30126-2766
US

V. Phone/Fax

Practice location:
  • Phone: 678-520-6566
  • Fax:
Mailing address:
  • Phone: 678-520-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003503
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: