Healthcare Provider Details

I. General information

NPI: 1053601807
Provider Name (Legal Business Name): RYAN JEWELL SCHLUETER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE STE 1275
ATLANTA GA
30308-2240
US

IV. Provider business mailing address

550 PEACHTREE ST NE STE 1275
ATLANTA GA
30308-2240
US

V. Phone/Fax

Practice location:
  • Phone: 404-872-3121
  • Fax: 404-334-4686
Mailing address:
  • Phone: 404-872-3121
  • Fax: 404-334-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number80379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: