Provider Demographics
NPI:1578542197
Name:ECHOLS, ERIC JEROME (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JEROME
Last Name:ECHOLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 SMOKERISE PT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4069
Mailing Address - Country:US
Mailing Address - Phone:770-486-5749
Mailing Address - Fax:
Practice Address - Street 1:1108 BULLSBORO DR
Practice Address - Street 2:SUITE G
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2190
Practice Address - Country:US
Practice Address - Phone:678-423-0100
Practice Address - Fax:678-423-9004
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0115421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1578542197OtherNPI