Healthcare Provider Details

I. General information

NPI: 1831227560
Provider Name (Legal Business Name): KIM EVELYN SCHULTHEISS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501
US

IV. Provider business mailing address

322 E CENTRAL BLVD UNIT 1009
ORLANDO FL
32801-4324
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-2627
  • Fax: 770-219-2627
Mailing address:
  • Phone: 770-219-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number4301087089
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036113869
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD60429831
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD60429831
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number074354
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: