Provider Demographics
NPI:1780658203
Name:DAVID E SCHOENFELD MD PC
Entity Type:Organization
Organization Name:DAVID E SCHOENFELD MD PC
Other - Org Name:DERMATOLOGY SPECIALISTS OF WEST GEORGIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SCHOENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-838-9333
Mailing Address - Street 1:157 CLINIC AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4413
Mailing Address - Country:US
Mailing Address - Phone:770-838-9333
Mailing Address - Fax:770-838-7755
Practice Address - Street 1:157 CLINIC AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4413
Practice Address - Country:US
Practice Address - Phone:770-838-9333
Practice Address - Fax:770-838-7755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040780207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5021Medicare ID - Type UnspecifiedMEDICARE GROUP #