Provider Demographics
NPI:1114954310
Name:SCHNELL, FREDERICK M (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:M
Last Name:SCHNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 1ST ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8300
Mailing Address - Country:US
Mailing Address - Phone:478-743-7068
Mailing Address - Fax:478-741-1354
Practice Address - Street 1:800 1ST ST
Practice Address - Street 2:SUITE 410
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8300
Practice Address - Country:US
Practice Address - Phone:478-743-7068
Practice Address - Fax:478-741-1354
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000237718FMedicaid
GA90BDBJPMedicare PIN
GA000237718FMedicaid
GAD30742Medicare UPIN