Healthcare Provider Details

I. General information

NPI: 1043353915
Provider Name (Legal Business Name): MELANIE M ECHOLS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEDICAL WAY
RIVERDALE GA
30274-2522
US

IV. Provider business mailing address

PO BOX 562
SMYRNA GA
30081-0562
US

V. Phone/Fax

Practice location:
  • Phone: 770-996-9725
  • Fax: 770-996-9724
Mailing address:
  • Phone: 770-996-9725
  • Fax: 770-996-9724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY002002
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: