Tara Roberts Spivey, PA-C, MPAS

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

003767 Issued in GA

Practice address

1400 Peterson Ave N Ste C
Douglas, GA 31533-2833

Phone

(912) 384-6276

NPI assigned

Jul 31, 2006

Last updated

Jan 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• 24 On Physicians, PC

  • Hospitalist Physician
  • Rome, GA
  • NPI 1912956251
  Medicare reassignment NPD
• Collins Cardiology

  • Cardiovascular Disease Physician
  • Douglas, GA
  • NPI 1528117728
  Medicare reassignment
• 24 On Physicians, P.C.

  • Hospitalist Physician
  • Attleboro, MA
  • NPI 1790104511
  NPD
• Collins Cardiology

  • Nuclear Cardiology Physician
  • Fitzgerald, GA
  • NPI 1245389006
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705622400000",
    "number": "1982610150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2109",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315342109",
            "telephone_number": "912-384-6276",
            "fax_number": "912-389-1618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 PETERSON AVE N STE C",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315332833",
            "telephone_number": "912-384-6276"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1208 Ocilla Rd",
            "address_purpose": "LOCATION",
            "city": "Douglas",
            "state": "GA",
            "postal_code": "315332220",
            "country_code": "US",
            "telephone_number": "912-384-6276",
            "fax_number": "912-389-1618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPIVEY",
        "first_name": "TARA",
        "middle_name": "ROBERTS",
        "name_prefix": "Mrs.",
        "credential": "PA-C, MPAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-31",
        "last_updated": "2024-01-19",
        "certification_date": "2024-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "003767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "791479760A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Speech Solutions LLC
• Heidi Allyn Spikes
• Jennifer Spivey
• Kameryn Spivey
• Sarah Olivia Shae Spivey, FNP
• Elizabeth G Stevens, LMT
• Kayla Shurai Stevens, NP-C
• Laura Melissa Steverson, NP-C
• Wycliff Harold Stewart, DC
• Regina Ann Stone, FNP-C

• Medical Physician Assistant in Douglas, GA
• Providers in Douglas, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.