Provider Demographics
NPI:1013905553
Name:MAYFIELD, MICHAEL E (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:630 HILLCREST RD NW
Mailing Address - Street 2:SUITE #400
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1710
Mailing Address - Country:US
Mailing Address - Phone:770-564-0590
Mailing Address - Fax:770-564-8565
Practice Address - Street 1:630 HILLCREST RD NW
Practice Address - Street 2:SUITE #400
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1710
Practice Address - Country:US
Practice Address - Phone:770-564-0590
Practice Address - Fax:770-564-8565
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0340232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC75850Medicare UPIN
GA26BDFMKMedicare ID - Type UnspecifiedMEDICARE