Provider Demographics
NPI:1437224011
Name:SCHOENFELD, GORDON OREN (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:OREN
Last Name:SCHOENFELD
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 1:1051 ACORN CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:GA
Mailing Address - Zip Code:30621-1373
Mailing Address - Country:US
Mailing Address - Phone:706-714-1001
Mailing Address - Fax:
Practice Address - Street 1:220 HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2148
Practice Address - Country:US
Practice Address - Phone:706-548-0500
Practice Address - Fax:706-548-3575
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN 70142085R0001X
GA587752085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA395657403AMedicaid
GA395657403AMedicaid