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General NPI Number Information
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NPI Number | 1669642484
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Entity Type | Individual
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Provider Name | LOUIS SPENCER M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 11/19/2015
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Provider Practice Location Address
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Address Line | 650 HENDERSON DRIVE SUITE 504
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City | CARTERSVILLE
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State | GA
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Zip | 30120
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Country | US
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Telephone | 770-607-9032
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Fax | 770-607-9035
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Provider Business Mailing Address
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Address Line | 650 HENDERSON DR STE 504
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3760
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Country | US
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Telephone | 770-607-9032
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Fax | 770-607-9035
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 061351
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License Number State | GA
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