Provider Demographics
NPI:1144213562
Name:SCHWARTZ, DELORES (PA-C)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N BELAIR RD
Mailing Address - Street 2:1B
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3188
Mailing Address - Country:US
Mailing Address - Phone:706-868-3100
Mailing Address - Fax:706-228-3125
Practice Address - Street 1:465 N BELAIR RD
Practice Address - Street 2:STE 1B
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3188
Practice Address - Country:US
Practice Address - Phone:706-868-3100
Practice Address - Fax:706-228-3125
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3502363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000433947BMedicaid
GAP18517Medicare UPIN
GA511I970453Medicare PIN