Provider Demographics
NPI:1558323550
Name:SCHULTZ, ALICE BETH (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:BETH
Last Name:SCHULTZ
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 1686
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1686
Mailing Address - Country:US
Mailing Address - Phone:800-346-1181
Mailing Address - Fax:706-232-0156
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-442-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03765207ZN0500X
GA037675207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZN0500XAllopathic & Osteopathic PhysiciansPathologyNeuropathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000832873BMedicaid
GA000832873BMedicaid
GAP00064970Medicare PIN
GA22BDDLFMedicare PIN