Provider Demographics
NPI:1942471800
Name:RICHARD J. SCHLEISSINGER D.P.M. P.C
Entity Type:Organization
Organization Name:RICHARD J. SCHLEISSINGER D.P.M. P.C
Other - Org Name:BUTLER CREEK PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHLEISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:770-529-9002
Mailing Address - Street 1:3459 ACWORTH DUE WEST RD NW
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-5819
Mailing Address - Country:US
Mailing Address - Phone:770-529-9002
Mailing Address - Fax:770-529-9004
Practice Address - Street 1:3459 ACWORTH DUE WEST RD NW
Practice Address - Street 2:SUITE 430
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-5819
Practice Address - Country:US
Practice Address - Phone:770-529-9002
Practice Address - Fax:770-529-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000867213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU73817Medicare UPIN
GA3998310001Medicare NSC
GA48SCCDGMedicare PIN