Provider Demographics
NPI:1689692972
Name:MAHAFFEY, EARL L (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:L
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 667
Mailing Address - Street 2:
Mailing Address - City:PRENTISS
Mailing Address - State:MS
Mailing Address - Zip Code:39474-0667
Mailing Address - Country:US
Mailing Address - Phone:601-792-2200
Mailing Address - Fax:601-792-2345
Practice Address - Street 1:1014 ROSE ST
Practice Address - Street 2:JEFFERSON DAVIS GENERAL HOSPITAL
Practice Address - City:PRENTISS
Practice Address - State:MS
Practice Address - Zip Code:39474-5271
Practice Address - Country:US
Practice Address - Phone:601-792-2200
Practice Address - Fax:601-792-2345
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS10777207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1130335Medicaid
B29906Medicare UPIN
MS1130335Medicaid