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General NPI Number Information
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NPI Number | 1760668396
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Entity Type | Individual
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Provider Name | JESSICA BRONWYN SPENCER MD
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Gender | Female
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 550 PEACHTREE RD. CRAWFORD LONG MEDICAL OFFICE TOWER, STE 1800
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 404-778-3401
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Fax | 404-686-4956
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Provider Business Mailing Address
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Address Line | 550 PEACHTREE RD. CRAWFORD LONG MEDICAL OFFICE TOWER, STE 1800
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone | 404-778-3401
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Fax | 404-686-4956
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 056926
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License Number State | GA
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