Provider Demographics
NPI:1861590457
Name:MCCEARLEY, SANDRA SPECKELS (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:SPECKELS
Last Name:MCCEARLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 LAKELAND DR STE 61
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4634
Mailing Address - Country:US
Mailing Address - Phone:601-982-7850
Mailing Address - Fax:601-366-8507
Practice Address - Street 1:970 LAKELAND DR STE 61
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-982-7850
Practice Address - Fax:601-366-8507
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013479207RC0000X, 207RC0001X
MS19433207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05002037Medicaid
MS6039138OtherHEALTHSPRING
MS7666474OtherCIGNA
MS9818622OtherAETNA
MS302I062729Medicare PIN
MS6039138OtherHEALTHSPRING