Healthcare Provider Details

I. General information

NPI: 1245779701
Provider Name (Legal Business Name): NOELAN SCHAFER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 WINFIELD DUNN PKWY STE 301
KODAK TN
37764-4319
US

IV. Provider business mailing address

4795 SUGARLOAF PARKWAY
BUFORD GA
30519
US

V. Phone/Fax

Practice location:
  • Phone: 865-465-7058
  • Fax:
Mailing address:
  • Phone: 470-223-3532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015714
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10572
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: