Provider Demographics
NPI:1255377123
Name:E-WAVE LLC
Entity type:Organization
Organization Name:E-WAVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:REX
Authorized Official - Last Name:ECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:RT, RDCS
Authorized Official - Phone:706-294-8613
Mailing Address - Street 1:4157 EAGLE NEST DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4809
Mailing Address - Country:US
Mailing Address - Phone:706-294-8613
Mailing Address - Fax:
Practice Address - Street 1:427 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3003
Practice Address - Country:US
Practice Address - Phone:706-294-8613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30538246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty