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Individual
JASON CHAUNCEY SPENCER
Active
Individual
JASON CHAUNCEY SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003768
GA
363A00000X
Physician Assistant
Primary
PA9103004
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100002298D
—
GA
05
—
100002298F
—
GA
01
—
10059208
AMERIGROUP
GA
Enumeration date
08/29/2006
Last updated
06/11/2008
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