Basic Information
| Provider Information | |||||||||
| NPI: | 1013108661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECKARD | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | ALEXIS | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 865 | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373980865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158498861 | ||||||||
| FaxNumber: | 9319676606 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 W 5TH STREET | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065095000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2007 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 42922 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 061577 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.