Provider Demographics
NPI:1558315713
Name:MICHAEL E MAYFIELD MD AND ASSOC PC
Entity Type:Organization
Organization Name:MICHAEL E MAYFIELD MD AND ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-564-0590
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3678Medicare ID - Type Unspecified