1922393909 NPI number — BRIAN RICHARD SCHULTZ M.D., PH.D.

NPI Number: 1922393909
Health Care Provider/Practitioner: BRIAN RICHARD SCHULTZ M.D., PH.D.

NPI Number : 1922393909 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922393909",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SCHULTZ",
    "FirstName": "BRIAN",
    "MiddleName": "RICHARD",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D., PH.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1705",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUGUSTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30903-1705",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": "208-215-2603",
    "FirstLinePracticeLocationAddress": "1350 WALTON WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUGUSTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30901-2612",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-722-9011",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/17/2011",
    "LastUpdateDate": "02/20/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "60878239",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "036133986",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "A153719",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "MD-17986",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "2021-02416",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "94058",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}