Provider Demographics
NPI:1659966190
Name:SCHMIDT, JOHNATHON (PA)
Entity Type:Individual
Prefix:
First Name:JOHNATHON
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CARNEGIE PL STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3900
Mailing Address - Country:US
Mailing Address - Phone:770-694-6349
Mailing Address - Fax:
Practice Address - Street 1:150 CARNEGIE PL STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3900
Practice Address - Country:US
Practice Address - Phone:177-069-4634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2022-12-03
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant