Provider Demographics
NPI:1447553292
Name:STANSTON D. SPENCE M.D., P.C.
Entity type:Organization
Organization Name:STANSTON D. SPENCE M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANSTON
Authorized Official - Middle Name:D'ANDREA
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-761-7482
Mailing Address - Street 1:777 CLEVELAND AVE SW
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7129
Mailing Address - Country:US
Mailing Address - Phone:404-761-7482
Mailing Address - Fax:404-761-8398
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:SUITE 305
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7129
Practice Address - Country:US
Practice Address - Phone:404-761-7482
Practice Address - Fax:404-761-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000415599BMedicaid
GA000415599BMedicaid
GAF21203Medicare UPIN