Healthcare Provider Details

I. General information

NPI: 1962924555
Provider Name (Legal Business Name): JOSEPH SAMUEL SCHERTZER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 BRIARVISTA WAY NE
ATLANTA GA
30329-3623
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-0001
US

V. Phone/Fax

Practice location:
  • Phone: 954-873-0605
  • Fax: 954-873-0605
Mailing address:
  • Phone: 813-821-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberME170848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: