Provider Demographics
NPI:1740209683
Name:SCHMALSTIEG, WALTER L JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:L
Last Name:SCHMALSTIEG
Suffix:JR
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 1:2615 COPPER CV
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-3002
Mailing Address - Country:US
Mailing Address - Phone:704-609-6885
Mailing Address - Fax:
Practice Address - Street 1:2615 COPPER CV
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-3002
Practice Address - Country:US
Practice Address - Phone:704-609-6885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96000422084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740209683Medicaid
SCN0004DMedicaid
NC2219516DMedicare PIN
NC2219516CMedicare PIN
NC1740209683Medicaid
NCNC1352AMedicare PIN
NC897487TMedicare PIN