Healthcare Provider Details

I. General information

NPI: 1134283542
Provider Name (Legal Business Name): AMY ANTHONY SPINKS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WEST FREEDOM DRIVE
LIBERTY MS
39645-0511
US

IV. Provider business mailing address

PO BOX 511
LIBERTY MS
39645-0511
US

V. Phone/Fax

Practice location:
  • Phone: 601-657-4326
  • Fax: 601-657-8867
Mailing address:
  • Phone: 601-657-4326
  • Fax: 601-657-8867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3380-06
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: