1003811886 NPI number — MR. DAVID J SCHOLL PA

Table of content: MR. DAVID J SCHOLL PA (NPI 1003811886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003811886 NPI number — MR. DAVID J SCHOLL PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOLL
Provider First Name:
DAVID
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003811886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
531 ROSELANE ST NW STE 710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-6975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-331-3297
Provider Business Mailing Address Fax Number:
678-581-7187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 CLINIC AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30117-4454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-333-2220
Provider Business Practice Location Address Fax Number:
678-581-7180
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  003286 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100001986C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1003811886 . This is a "NPI NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 891003510 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100001986B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100001986A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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