Provider Demographics
| NPI: | 1003811886 |
|---|---|
| Name: | SCHOLL, DAVID J (PA) |
| Entity type: | Individual |
| Prefix: | MR |
| First Name: | DAVID |
| Middle Name: | J |
| Last Name: | SCHOLL |
| Suffix: | |
| Gender: | M |
| Credentials: | PA |
| Other - Prefix: | |
| Other - First Name: | |
| Other - Middle Name: | |
| Other - Last Name: | |
| Other - Suffix: | |
| Other - Last Name Type: | |
| Other - Credentials: | |
| Mailing Address - Street 1: | 531 ROSELANE ST NW STE 710 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MARIETTA |
| Mailing Address - State: | GA |
| Mailing Address - Zip Code: | 30060-6975 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 678-331-3297 |
| Mailing Address - Fax: | 678-581-7187 |
| Practice Address - Street 1: | 157 CLINIC AVE STE 101 |
| Practice Address - Street 2: | |
| Practice Address - City: | CARROLLTON |
| Practice Address - State: | GA |
| Practice Address - Zip Code: | 30117-4454 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 770-333-2220 |
| Practice Address - Fax: | 678-581-7180 |
| Is Sole Proprietor?: | No |
| Enumeration Date: | 2005-06-17 |
| Last Update Date: | 2018-01-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| GA | 003286 | 363AM0700X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| GA | 100001986C | Medicaid | |
| GA | 1003811886 | Other | NPI NUMBER |
| AL | 891003510 | Medicaid | |
| GA | 100001986B | Medicaid | |
| GA | 100001986A | Medicaid | |
| GA | S89414 | Medicare UPIN |