Basic Information
| Provider Information | |||||||||
| NPI: | 1861590457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCEARLEY | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | SPECKELS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 970 LAKELAND DR STE 61 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392164634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019827850 | ||||||||
| FaxNumber: | 6013668507 | ||||||||
| Practice Location | |||||||||
| Address1: | 970 LAKELAND DR STE 61 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 39216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019827850 | ||||||||
| FaxNumber: | 6013668507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 2012013479 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 2012013479 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | 19433 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 05002037 | 05 | MS | MEDICAID | 7666474 | 01 | MS | CIGNA | OTHER | 9818622 | 01 | MS | AETNA | OTHER | 6039138 | 01 | MS | HEALTHSPRING | OTHER |