MEDICARE: JIMMY A. SPIVEY, M.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	012572	GA

General Provider Information

NPI Number	:	1871793794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIMMY A. SPIVEY, M.D., P.C.

Provider Business Mailing Address
First Line	:	5303 ADAMS ST NE
Second Line	:	STE A
City	:	COVINGTON
State	:	GA
Zip	:	30014-6208
Country	:	US
Telephone Number	:	770-786-7971
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 ADAMS ST NE
Second Line	:	STE A
City	:	COVINGTON
State	:	GA
Zip	:	30014-6208
Country	:	US
Telephone Number	:	770-786-7971
Fax Number	:

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	JIMMY A SPIVEY
Credential	:	M.D.
Telephone Number	:	770-714-3876

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	02/01/2008

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