Healthcare Provider Details

I. General information

NPI: 1063727394
Provider Name (Legal Business Name): DAVID M. SCHWARTZ, PH.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 POWERS FERRY RD SE BUILDING 22
ATLANTA GA
30339-5621
US

IV. Provider business mailing address

1827 POWERS FERRY RD SE BUILDING 22
ATLANTA GA
30339-5621
US

V. Phone/Fax

Practice location:
  • Phone: 770-973-7401
  • Fax: 770-973-7420
Mailing address:
  • Phone: 770-973-7401
  • Fax: 770-973-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1165
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID M SCHWARTZ
Title or Position: PRESIDENT, CEO
Credential: PH.D.
Phone: 770-973-7401