Provider Demographics
NPI:1306466214
Name:EICHHORN, SHEELA M
Entity type:Individual
Prefix:
First Name:SHEELA
Middle Name:M
Last Name:EICHHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 ELMA G MILES PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-570-9898
Mailing Address - Fax:912-877-4030
Practice Address - Street 1:951 ELMA G MILES PKWY
Practice Address - Street 2:STE B
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4514
Practice Address - Country:US
Practice Address - Phone:912-876-2206
Practice Address - Fax:912-877-4030
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-21
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000307225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1306466214OtherOPTUM COMMUNITY CARE