Provider Demographics
NPI:1386649085
Name:SCHUMANN, SAMUEL OWENS JR (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:OWENS
Last Name:SCHUMANN
Suffix:JR
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:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:104 FUNK AVE
Practice Address - Street 2:
Practice Address - City:SAINT STEPHEN
Practice Address - State:SC
Practice Address - Zip Code:29479-3383
Practice Address - Country:US
Practice Address - Phone:843-567-3206
Practice Address - Fax:843-567-3287
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC135507Medicaid
SCP00449862OtherRR MEDICARE
SCGPPA0169OtherMEDICAID GROUP
SCGP3821OtherMEDICAID GROUP LIVE OAK
SCP00449862OtherRR MEDICARE
SCGPPA0169OtherMEDICAID GROUP
SCD72068Medicare UPIN
SCD720687126Medicare PIN