Healthcare Provider Details

I. General information

NPI: 1538374376
Provider Name (Legal Business Name): EARL J SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WESTPARK DR SUITE 100
PEACHTREE CITY GA
30269-1575
US

IV. Provider business mailing address

525 WESTPARK DR SUITE 100
PEACHTREE CITY GA
30269-1575
US

V. Phone/Fax

Practice location:
  • Phone: 770-487-0029
  • Fax: 770-692-0116
Mailing address:
  • Phone: 770-487-0029
  • Fax: 770-692-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number055703
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: