MEDICARE: SPEARS MEDICAL CLINIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1679628697	OTHER	MS	NPPES NPI REGISTRY

General Provider Information

NPI Number	:	1003497751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEARS MEDICAL CLINIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 54
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-0054
Country	:	US
Telephone Number	:	601-608-0900
Fax Number	:	601-600-2171

Provider Business Practice Location Address
First Line	:	804 ROBB ST
Second Line	:
City	:	SUMMIT
State	:	MS
Zip	:	39666-8291
Country	:	US
Telephone Number	:	601-608-0900
Fax Number	:	601-600-2171

Authorized Official
Title or Position	:	OWNER
Name	:	DAMON SCOTT SPEARS
Credential	:	FNP-C
Telephone Number	:	601-600-6522

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/30/2025

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Directions to “SPEARS MEDICAL CLINIC PLLC ” Practice Location

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