Provider Demographics
NPI:1285948414
Name:SCHAEFER, JOHN W (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 12TH ST NE STE 1B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4009
Mailing Address - Country:US
Mailing Address - Phone:404-815-4800
Mailing Address - Fax:404-815-0002
Practice Address - Street 1:222 12TH ST NE STE 1B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4009
Practice Address - Country:US
Practice Address - Phone:404-815-4800
Practice Address - Fax:404-815-0002
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029281122300000X
FLDN 180941223P0300X
IL021.0024991223P0300X
MO20120101281223P0300X
GADN0160821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist