Provider Demographics
NPI:1427583616
Name:SCHULTZ, ANDREW M (FNP-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:M
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 FOSTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5330
Mailing Address - Country:US
Mailing Address - Phone:770-506-4119
Mailing Address - Fax:
Practice Address - Street 1:156 FOSTER DR STE B
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5330
Practice Address - Country:US
Practice Address - Phone:770-506-4119
Practice Address - Fax:770-506-4145
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006222363L00000X
GARN270279363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95006222OtherNP LICENSE
CA851251OtherREGISTERED NURSE