Basic Information
Provider Information
NPI: 1447660840
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SPENCE
FirstName: LINSEY
MiddleName: HUDSON
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1350 S KINGS DR
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282072134
CountryCode: US
TelephoneNumber: 7044461242
FaxNumber: 7044461241
Practice Location
Address1: 1350 S KINGS DR
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282072134
CountryCode: US
TelephoneNumber: 7044461242
FaxNumber: 7044461241
Other Information
ProviderEnumerationDate: 05/07/2014
LastUpdateDate: 02/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X201524NCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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