Provider Demographics
NPI:1659426401
Name:EICHLER, EDWARD (PHD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:EICHLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MAYBELLE ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3617
Mailing Address - Country:US
Mailing Address - Phone:678-592-6305
Mailing Address - Fax:
Practice Address - Street 1:105 MAYBELLE ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3617
Practice Address - Country:US
Practice Address - Phone:678-592-6305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGRDMedicare PIN