MEDICARE: DR. DAVID ALLEN ECKLUND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	45529	MN
2	208000000X	Pediatrics Physician	057067	GA

General Provider Information

NPI Number	:	1861454894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALLEN ECKLUND MD

Provider Business Mailing Address
First Line	:	3495 PIEDMONT RD NE
Second Line	:	NINE PIEDMONT CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30305-1717
Country	:	US
Telephone Number	:	404-364-7000
Fax Number	:	404-364-4732

Provider Business Practice Location Address
First Line	:	2525 CUMBERLAND PKWY SE
Second Line	:	PEDIATRICS HEALTH CARE TEAM A
City	:	ATLANTA
State	:	GA
Zip	:	30339-3915
Country	:	US
Telephone Number	:	770-431-4251
Fax Number	:	770-431-4317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	01/13/2022

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