Organization
MARK SPIVEY ORTHOPEDIC CLINIC, LLC
Active
Other names
Mark Spivey Orthopedic Clinic, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES M SPIVEY MD (OWNER)
(912) 537-4411
Entity
Organization
Contact information
Practice address
3301 E 1ST ST, STE A, VIDALIA, GA 30474-8674
(912) 537-4411
(912) 538-8485
Mailing address
3301 E 1ST ST, STE A, VIDALIA, GA 30474-8674
(912) 537-4411
(912) 538-8485
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
047846
GA
207X00000X
Orthopaedic Surgery Physician
—
GA
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501468518E
—
GA
Enumeration date
08/07/2007
Last updated
03/14/2025
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