Provider Demographics
NPI:1447280045
Name:SPILKER, EDWARD FRASER (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRASER
Last Name:SPILKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1690 STONE VILLAGE LANE NW
Mailing Address - Street 2:SUITE 921
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7714
Mailing Address - Country:US
Mailing Address - Phone:770-590-1440
Mailing Address - Fax:770-792-9231
Practice Address - Street 1:1690 STONE VILLAGE LANE NW
Practice Address - Street 2:SUITE 921
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7714
Practice Address - Country:US
Practice Address - Phone:770-590-1440
Practice Address - Fax:770-792-9231
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I081393OtherMEDICARE PTAN
GA202I081393OtherMEDICARE PTAN
GAC89514Medicare UPIN