Individual provider Active NPI

Kevin Mitchell Spikes, FNP

  • Family Nurse Practitioner
  • Marietta, GA
National Provider Identifier
1083315659
Registry record updated May 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN278291 Issued in GA
Practice address
3801 Oxford Way E
Marietta, GA 30062-4160
Phone
(229) 569-0815
NPI assigned
Mar 13, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 40900 TN
Family Nurse Practitioner 363LF0000X 31579 SC
Family Nurse Practitioner 363LF0000X RN278291 GA Primary
Family Nurse Practitioner 363LF0000X 3-002757 AL
Family Nurse Practitioner 363LF0000X C-APN.0105834-C-NP CO

Addresses

Primary practice location

3801 Oxford Way E
Marietta, GA 30062-4160

Mailing address

3801 Oxford Way E
Marietta, GA 30062-4160

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230623000165 GA Practitioner - Nurse Practitioner 7618335688 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3-002757ALMDFamily Nurse Practitioner
C-APN.0105834-C-NPCOMDFamily Nurse Practitioner
31579SCMDFamily Nurse Practitioner
40900TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Medical Group, P.C. CurrentSince Apr 22, 2024 Accepting new patients
Community Care Health Network LLC CurrentSince Nov 1, 2025 Accepting new patients
Physician First Health Network PastSince Jun 3, 2025 Accepting new patients

Locations

9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883

1000 Parkwood Cir SE
Ste 900
Atlanta, GA 30339
Phone (216) 393-8684

1255 Friendship Rd
Ste 130
Braselton, GA 30517
Phone (678) 341-6350

141 Lacy St NW
Ste 100
Marietta, GA 30060
Phone (770) 615-1350

4800 Olde Towne Pkwy
Ste 320
Marietta, GA 30068
Phone (678) 341-6370

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779148800000",
    "number": "1083315659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 OXFORD WAY E",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300624160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 OXFORD WAY E",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300624160",
            "telephone_number": "229-569-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPIKES",
        "first_name": "KEVIN",
        "middle_name": "MITCHELL",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-13",
        "last_updated": "2026-05-19",
        "certification_date": "2026-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "40900",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "31579",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN278291",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "3-002757",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "C-APN.0105834-C-NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.