Provider Demographics
NPI:1649626938
Name:SCHULTZ, ALEX PHILLIP (PA-C, MMSC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:PHILLIP
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 WILMER ST NE
Mailing Address - Street 2:UNIT 1230
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2933
Mailing Address - Country:US
Mailing Address - Phone:504-239-3467
Mailing Address - Fax:
Practice Address - Street 1:476 WILMER ST NE
Practice Address - Street 2:UNIT 1230
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2933
Practice Address - Country:US
Practice Address - Phone:504-239-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7967363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical