Provider Demographics
NPI:1013108661
Name:ECKARD, ALEXIS ANN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:ECKARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 865
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-0865
Mailing Address - Country:US
Mailing Address - Phone:615-849-8861
Mailing Address - Fax:931-967-6606
Practice Address - Street 1:255 W 5TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:706-509-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN42922207Q00000X
GA061577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I080512Medicare PIN