Healthcare Provider Details

I. General information

NPI: 1659539328
Provider Name (Legal Business Name): LORI SCHWAM, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4424 COLUMBIA RD SUITE B
AUGUSTA GA
30907-4565
US

IV. Provider business mailing address

PO BOX 211957
AUGUSTA GA
30917-1957
US

V. Phone/Fax

Practice location:
  • Phone: 706-993-3187
  • Fax: 706-210-9308
Mailing address:
  • Phone: 706-836-9379
  • Fax: 706-228-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI SCHWAM
Title or Position: DIRECTOR
Credential: M.D.
Phone: 706-836-9379