Provider Demographics
NPI:1619331873
Name:SPIVEY, MATTHEW GRAY (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GRAY
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-893-2400
Mailing Address - Fax:336-893-2410
Practice Address - Street 1:7210 VILLAGE MEDICAL CIR STE 110
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8041
Practice Address - Country:US
Practice Address - Phone:336-893-2400
Practice Address - Fax:336-893-2410
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01290207XX0005X, 207X00000X, 207X00000X, 207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program