NPI Code Detail JSON Logo

1124808001 NPI number — CHRISTOPHER SPENCER WEST PHYSICIAN ASSISTANT

NPI Number: 1124808001
Health Care Provider/Practitioner: CHRISTOPHER SPENCER WEST PHYSICIAN ASSISTANT

Information about “1124808001” NPI (CHRISTOPHER SPENCER WEST PHYSICIAN ASSISTANT) exists in 1124808001 in HTML format HTML  |  1124808001 in plain Text format TXT  |  1124808001 in PDF (Portable Document Format) PDF  |  1124808001 in an XML format XML  formats.

NPI Number : 1124808001 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124808001",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WEST",
    "FirstName": "CHRISTOPHER",
    "MiddleName": "SPENCER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHYSICIAN ASSISTANT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4850 KINGS WOOD DR NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROSWELL",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30075-4009",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-708-7306",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1240 JESSE JEWELL PKWY SE STE 300",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GAINESVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30501-3861",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-532-7202",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/29/2023",
    "LastUpdateDate": "04/07/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "11914",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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