Provider Demographics
NPI:1043353915
Name:ECHOLS, MELANIE M (PHD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:ECHOLS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 PHOENIX BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5544
Mailing Address - Country:US
Mailing Address - Phone:770-996-9725
Mailing Address - Fax:770-996-9724
Practice Address - Street 1:1597 PHOENIX BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5544
Practice Address - Country:US
Practice Address - Phone:770-996-9725
Practice Address - Fax:770-996-9724
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10036639OtherAMERIGROUP