Provider Demographics
NPI:1275936379
Name:GEORGE L ECKLES MD
Entity Type:Organization
Organization Name:GEORGE L ECKLES MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ECKLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-890-8069
Mailing Address - Street 1:2811 WINDSONG PL
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-6558
Mailing Address - Country:US
Mailing Address - Phone:615-890-8069
Mailing Address - Fax:615-624-6339
Practice Address - Street 1:642 DUNLOP LANE
Practice Address - Street 2:GATEWAY WOUND CENTER
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040
Practice Address - Country:US
Practice Address - Phone:615-890-8069
Practice Address - Fax:615-624-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8257208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND70211Medicare UPIN