Healthcare Provider Details

I. General information

NPI: 1003497751
Provider Name (Legal Business Name): SPEARS MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 ROBB ST
SUMMIT MS
39666-8291
US

IV. Provider business mailing address

PO BOX 54
SUMMIT MS
39666-0054
US

V. Phone/Fax

Practice location:
  • Phone: 601-608-0900
  • Fax: 601-600-2171
Mailing address:
  • Phone: 601-608-0900
  • Fax: 601-600-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAMON SCOTT SPEARS
Title or Position: OWNER
Credential: FNP-C
Phone: 601-600-6522