Provider Demographics
NPI:1972584498
Name:SCHANCUPP, JOEL E (DPM)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:SCHANCUPP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1030 WOODSTOCK RD
Mailing Address - Street 2:STE 3106
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-8271
Mailing Address - Country:US
Mailing Address - Phone:770-993-0880
Mailing Address - Fax:770-993-9722
Practice Address - Street 1:1030 WOODSTOCK RD
Practice Address - Street 2:STE 3106
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-8271
Practice Address - Country:US
Practice Address - Phone:770-993-0880
Practice Address - Fax:770-993-9722
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2013-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPOD 000506213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00263062AMedicaid
GA1195170001Medicare NSC