Provider Demographics
NPI:1376528836
Name:SCHWAM, LORI GAIL (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:GAIL
Last Name:SCHWAM
Suffix:
Gender:F
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:PO BOX 211957
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-1957
Mailing Address - Country:US
Mailing Address - Phone:706-651-1260
Mailing Address - Fax:706-651-1383
Practice Address - Street 1:465 N BELAIR RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3188
Practice Address - Country:US
Practice Address - Phone:706-651-1260
Practice Address - Fax:706-651-1383
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0267512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA239596957AMedicaid
GA26BDJCGMedicare ID - Type Unspecified
GA239596957AMedicaid