Provider Demographics
NPI:1790784593
Name:SCHMIDT, STEPHEN LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEWIS
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:465 N BELAIR RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3188
Mailing Address - Country:US
Mailing Address - Phone:706-854-2160
Mailing Address - Fax:706-854-2930
Practice Address - Street 1:465 N BELAIR RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3188
Practice Address - Country:US
Practice Address - Phone:706-854-2160
Practice Address - Fax:706-854-2930
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA047149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08CBBKFMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
G98523Medicare UPIN