MEDICARE: DR. JONATHAN EDWIN SCHMALZ PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	5893	NC

General Provider Information

NPI Number	:	1306485974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN EDWIN SCHMALZ PHD

Provider Business Mailing Address
First Line	:	4007 WATAUGA DR
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27410-4501
Country	:	US
Telephone Number	:	281-744-1275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911-A PINEDALE RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408
Country	:	US
Telephone Number	:	336-443-6762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2019
Last Update Date	:	12/16/2025

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