Healthcare Provider Details

I. General information

NPI: 1154966208
Provider Name (Legal Business Name): KATHLEEN LYMAN SCHAAF PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 PEACHFORD RD STE H
DUNWOODY GA
30338-6539
US

IV. Provider business mailing address

4510 VILLAGE DR
DUNWOODY GA
30338-5743
US

V. Phone/Fax

Practice location:
  • Phone: 770-454-1256
  • Fax:
Mailing address:
  • Phone: 256-684-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number226673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: