Active NPI
Piccina R Spence, PA-C
- Medical Physician Assistant
- Ft Stewart, GA
National Provider Identifier
1417949082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 02958
- Practice address
- 192 Lindquist Rd
BLD 412, Tfcmc
Ft Stewart, GA 31314-5122 - Phone
- (912) 435-6633
- NPI assigned
- Aug 18, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 02958 | GA | Primary |
Addresses
Primary practice location
192 Lindquist Rd
BLD 412, Tfcmc
Ft Stewart, GA 31314-5122
Mailing address
1061 Harmon Ave, Suite 1D03
Winn Army Community Hospital
Ft. Stewart, GA 31315
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02958 | GA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124323200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285891200000",
"number": "1417949082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1061 HARMON AVE, SUITE 1D03",
"address_2": "WINN ARMY COMMUNITY HOSPITAL",
"city": "FT. STEWART",
"state": "GA",
"postal_code": "31315"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "192 LINDQUIST RD",
"address_2": "BLD 412, TFCMC",
"city": "FT STEWART",
"state": "GA",
"postal_code": "313145122",
"telephone_number": "912-435-6633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPENCE",
"first_name": "PICCINA",
"middle_name": "R",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-18",
"last_updated": "2010-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "GA",
"license": "02958",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft Stewart, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.