Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 010648 | GA |
NPI | 1003920794 |
---|---|
Provider Name | Dr. Jeffrey D Schultz |
First Address | Peachtree City, GA 30269-4050 |
Second Address | Newnan, GA 30263-5822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 06/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U41793 | (02) | GA |