Healthcare Provider Details

I. General information

NPI: 1538574074
Provider Name (Legal Business Name): JOSEPH SCHNEIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

303 PARKWAY DR NE
ATLANTA GA
30312-1212
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6827
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA161288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: