Provider Demographics
NPI:1295135549
Name:SCHRADER, DAVID (MS, ATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1197 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2718
Mailing Address - Country:US
Mailing Address - Phone:770-973-7200
Mailing Address - Fax:
Practice Address - Street 1:1197 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2718
Practice Address - Country:US
Practice Address - Phone:770-973-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities