Individual
MRS. TARA ROBERTS SPIVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MPAS
Contact information
Practice address
1400 PETERSON AVE N STE C, DOUGLAS, GA 31533-2833
(912) 384-6276
Mailing address
PO BOX 2109, DOUGLAS, GA 31534-2109
(912) 384-6276
(912) 389-1618
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003767
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
791479760A
—
GA
Enumeration date
07/31/2006
Last updated
01/19/2024
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