Provider Demographics
NPI:1881951218
Name:SCHULTZ, EDITH A (CEO)
Entity type:Individual
Prefix:MS
First Name:EDITH
Middle Name:A
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:MS
Other - First Name:EDITH
Other - Middle Name:A
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:IMPORT DISTRIBUTOR
Mailing Address - Street 1:204 MEADOW RUN
Mailing Address - Street 2:204 MEADOW RUN
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3412
Mailing Address - Country:US
Mailing Address - Phone:678-826-9204
Mailing Address - Fax:770-486-8245
Practice Address - Street 1:204 MEADOW RUN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3412
Practice Address - Country:US
Practice Address - Phone:470-214-7751
Practice Address - Fax:770-486-8425
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA302R00000X302R00000X
GA332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No302R00000XManaged Care OrganizationsHealth Maintenance Organization