Provider Demographics
NPI:1700831849
Name:SCHWAIBOLD, FREDERICK PAUL (DO)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:PAUL
Last Name:SCHWAIBOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:FREDERICK
Other - Middle Name:PAUL
Other - Last Name:SCHWAIBOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:DEPT OF RADIATION ONCOLOGY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:404-605-4227
Mailing Address - Fax:404-605-1702
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:DEPT OF RADIATION ONCOLOGY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-4227
Practice Address - Fax:404-605-1702
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0342402085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA005128280Medicaid
GA92BDBDZMedicare ID - Type Unspecified
GA005128280Medicaid