Provider Demographics
NPI:1386709699
Name:SCHMIDT, JOHN W (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1065 JODECO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4953
Mailing Address - Country:US
Mailing Address - Phone:678-284-6300
Mailing Address - Fax:678-284-6282
Practice Address - Street 1:3345 HIGHWAY 34 E
Practice Address - Street 2:SUITE 101
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3563
Practice Address - Country:US
Practice Address - Phone:770-502-8005
Practice Address - Fax:770-502-1825
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA001901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00270613OtherRR MEDICARE
GAQ25451Medicare UPIN
GAP00270613OtherRR MEDICARE