Healthcare Provider Details

I. General information

NPI: 1841954112
Provider Name (Legal Business Name): JAMES SCHMIDT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2021
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 PONCE DE LEON AVE NE
ATLANTA GA
30308-1920
US

IV. Provider business mailing address

265 PONCE DE LEON AVE NE
ATLANTA GA
30308-1920
US

V. Phone/Fax

Practice location:
  • Phone: 404-685-8883
  • Fax:
Mailing address:
  • Phone: 404-685-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: