Healthcare Provider Details

I. General information

NPI: 1013381391
Provider Name (Legal Business Name): DONALD CRAIG SPOON NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DONALD SPOON NP

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 W SPRING ST
MONROE GA
30655-3115
US

IV. Provider business mailing address

1621 HIGHLAND CREEK DR
MONROE GA
30656-2508
US

V. Phone/Fax

Practice location:
  • Phone: 770-267-1789
  • Fax:
Mailing address:
  • Phone: 470-564-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN213238
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN213238
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024192765
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: