Provider Demographics
NPI:1639373467
Name:ECKARD, WILLIAM DAVID (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAVID
Last Name:ECKARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 JOHN MADDOX DR NW
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1431
Mailing Address - Country:US
Mailing Address - Phone:706-368-8022
Mailing Address - Fax:706-368-8012
Practice Address - Street 1:501 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1415
Practice Address - Country:US
Practice Address - Phone:706-291-0291
Practice Address - Fax:706-368-8012
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060726207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA910628834DMedicaid
GA910628834CMedicaid