Provider Demographics
NPI:1578875480
Name:EICHENLAUB, MANDY KALE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:KALE
Last Name:EICHENLAUB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:KALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 KING AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2838
Mailing Address - Country:US
Mailing Address - Phone:706-425-2400
Mailing Address - Fax:706-425-2410
Practice Address - Street 1:830 KING AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2838
Practice Address - Country:US
Practice Address - Phone:706-425-2400
Practice Address - Fax:706-425-2410
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105741AMedicaid