1174628127 NPI number — CATHERINE SCHWENDER MD

Table of content: CATHERINE SCHWENDER MD (NPI 1174628127)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174628127 NPI number — CATHERINE SCHWENDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWENDER
Provider First Name:
CATHERINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHWENDER
Provider Other First Name:
CATHERINE
Provider Other Middle Name:
ELIZABETH BATH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1174628127
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1150 GOLDEN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30677-7712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-612-9401
Provider Business Mailing Address Fax Number:
706-612-9420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2142 W BROAD ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-3506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-612-9401
Provider Business Practice Location Address Fax Number:
706-612-9410
Provider Enumeration Date:
09/14/2006

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: 208800000X , with the licence number:  059189 , 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: 664249432K , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 664249432J , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 664249432I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 664249432L , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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