Provider Demographics
NPI:1144218801
Name:SPIVEY, JIMMY A (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:A
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1765 OLD WEST BROAD ST
Mailing Address - Street 2:BLDG 2, STE 200
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-549-1663
Mailing Address - Fax:706-546-8792
Practice Address - Street 1:5303 ADAMS ST NE
Practice Address - Street 2:STE A
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-6208
Practice Address - Country:US
Practice Address - Phone:706-549-1663
Practice Address - Fax:706-546-8792
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2015-03-24
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Provider Licenses
StateLicense IDTaxonomies
GA012572207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000143932KMedicaid
GA000143932KMedicaid
GAC65573Medicare UPIN
GA000143932GMedicaid
GA000143932HMedicaid