Provider Demographics
NPI:1023003993
Name:MCKINLEY, MARY E (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:MCKINLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:360 HOSPITAL DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3874
Mailing Address - Country:US
Mailing Address - Phone:478-841-2707
Mailing Address - Fax:478-841-2708
Practice Address - Street 1:360 HOSPITAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3874
Practice Address - Country:US
Practice Address - Phone:478-841-2707
Practice Address - Fax:478-841-2708
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA51256207R00000X
GA051256208000000X
TXT2435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000954005AMedicaid
GA11SCGLQMedicare PIN
GAH62336Medicare UPIN