Provider Demographics
NPI:1689676553
Name:SCHWEISTRIS, JOHN ERICH III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ERICH
Last Name:SCHWEISTRIS
Suffix:III
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 1:2148 GROVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9701
Mailing Address - Country:US
Mailing Address - Phone:912-925-4264
Mailing Address - Fax:912-925-4264
Practice Address - Street 1:2148 GROVE POINT RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9701
Practice Address - Country:US
Practice Address - Phone:912-925-4264
Practice Address - Fax:912-925-4264
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018420207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00143965AMedicaid
INP00834921OtherRAILROAD MEDICARE
GA00143965AMedicaid
IN859910D3Medicare PIN
IN192770A6Medicare PIN
IN265130QQQMedicare PIN
GAD41076Medicare UPIN