Healthcare Provider Details

I. General information

NPI: 1376184630
Provider Name (Legal Business Name): KYLE ROBERT SCHNEIDER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8954 HOSPITAL DR
DOUGLASVILLE GA
30134-2272
US

IV. Provider business mailing address

2535 WEBER HEIGHTS WAY
BUFORD GA
30519-3479
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-1500
  • Fax:
Mailing address:
  • Phone: 678-665-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: