Healthcare Provider Details

I. General information

NPI: 1255320719
Provider Name (Legal Business Name): MICHAEL DANIEL ECHEMENDIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11975 MORRIS RD SUITE 200
ALPHARETTA GA
30005-4419
US

IV. Provider business mailing address

5780 PEACHTREE DUNWOODY ROAD SUITE 300
ATLANTA GA
30342-1513
US

V. Phone/Fax

Practice location:
  • Phone: 770-751-3600
  • Fax: 770-751-3615
Mailing address:
  • Phone: 404-303-1224
  • Fax: 404-303-1325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number019880
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: