Provider Demographics
NPI:1255433504
Name:NEAL, MARY JOYCE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOYCE
Last Name:NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:JOYCE
Other - Last Name:NEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-888-6559
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:327-3 SUNSET AVENUE SW
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:GA
Practice Address - Zip Code:39870
Practice Address - Country:US
Practice Address - Phone:229-734-5250
Practice Address - Fax:229-734-5606
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029357208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA238988OtherBCBS - EAPC
GA370004359OtherRR MCARE - BCPHC
GA5095044OtherAETNA
GA000436532AMedicaid
GA239001OtherBCBS - BCPHC
GA700008517OtherRR MCARE - EAPC
GA370004359OtherRR MCARE - BCPHC
GA5095044OtherAETNA