1114264652 NPI number — DR. JACLYN MARIE SCHWARTZ D.P.M.

Table of content: DR. JACLYN MARIE SCHWARTZ D.P.M. (NPI 1114264652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114264652 NPI number — DR. JACLYN MARIE SCHWARTZ D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
JACLYN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

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:
1114264652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3495 PIEDMONT RD NE
Provider Second Line Business Mailing Address:
NINE PIEDMONT CENTER
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30305-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-504-5678
Provider Business Mailing Address Fax Number:
404-446-1957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 MOUNT ZION PKWY
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE SOUTHWOOD COMPREHENSIVE MEDICAL CENTE
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-663-8011
Provider Business Practice Location Address Fax Number:
770-754-9820
Provider Enumeration Date:
01/03/2013

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: 213ES0103X , with the licence number:  POD001186 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: POD001186 , 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)





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