Provider Demographics
NPI:1194879361
Name:ECHOLS, JOSEPH MARTIN JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MARTIN
Last Name:ECHOLS
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11 BRISTLECONE WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4536
Mailing Address - Country:US
Mailing Address - Phone:706-736-6254
Mailing Address - Fax:706-592-5934
Practice Address - Street 1:1414 MARKS CHURCH RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-2430
Practice Address - Country:US
Practice Address - Phone:706-738-8919
Practice Address - Fax:706-592-5934
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA91541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100971OtherAVESIS
GA9183202OtherDORAL
GA00200472AMedicaid
GA00200472BMedicaid
GA649764OtherUNITED CONCORDIA