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General NPI Number Information
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NPI Number | 1861590457
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Entity Type | Individual
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Provider Name | SANDRA SPECKELS MCCEARLEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 970 LAKELAND DR STE 61
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City | JACKSON
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State | MS
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Zip | 39216
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Country | US
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Telephone | 601-982-7850
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Fax | 601-366-8507
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Provider Business Mailing Address
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Address Line | 970 LAKELAND DR STE 61
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City | JACKSON
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State | MS
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Zip | 39216-4634
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Country | US
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Telephone | 601-982-7850
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Fax | 601-366-8507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2012013479
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 2012013479
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 19433
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License Number State | MS
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