Healthcare Provider Details

I. General information

NPI: 1952378408
Provider Name (Legal Business Name): KAREN S.P. ESCHEDOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4948 GUMLOG RD
MARTIN GA
30557-2921
US

IV. Provider business mailing address

4831 GUMLOG RD
MARTIN GA
30557-2933
US

V. Phone/Fax

Practice location:
  • Phone: 706-356-1111
  • Fax: 706-356-1112
Mailing address:
  • Phone: 706-356-1111
  • Fax: 706-356-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number034824
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: