Healthcare Provider Details

I. General information

NPI: 1376910547
Provider Name (Legal Business Name): LYUDMILA BORISOVNA SCHULTZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 10/12/2025
Certification Date: 10/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3507
US

IV. Provider business mailing address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3507
US

V. Phone/Fax

Practice location:
  • Phone: 706-443-5273
  • Fax:
Mailing address:
  • Phone: 706-443-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9317791
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberGAA-NP001728
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9317791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: