Provider Demographics
NPI:1255320719
Name:ECHEMENDIA, MICHAEL DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:ECHEMENDIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:11975 MORRIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4419
Practice Address - Country:US
Practice Address - Phone:770-751-3600
Practice Address - Fax:770-751-3615
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2016-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA019880207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000252535CMedicaid
GA000252535LMedicaid
GA000252535EMedicaid
GA000252535KMedicaid
GA000252535CMedicaid