1033139050 NPI number — ANDREAS SCHILLING MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033139050 NPI number — ANDREAS SCHILLING MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SCHILLING

Provider First Name:

ANDREAS

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1033139050

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/30/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 14185

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SAVANNAH

Provider Business Mailing Address State Name:

GA

Provider Business Mailing Address Postal Code:

31416-1185

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

912-898-0536

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

4700 WATERS AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SAVANNAH

Provider Business Practice Location Address State Name:

GA

Provider Business Practice Location Address Postal Code:

31404-6220

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

912-350-8436

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

07/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  22335 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 23387 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 33206 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 058004 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 10068472 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 223350 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
• Identifier: 116825376A . This is a "PEACH STATE HEALTH PLAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: N347033 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 116825376A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00340688 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 52212349001 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 013276400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".