Provider Demographics
NPI:1932575966
Name:SCHNEIDER, RANDOLPH (APC)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 HARRIS TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4409
Mailing Address - Country:US
Mailing Address - Phone:770-815-7212
Mailing Address - Fax:
Practice Address - Street 1:4711 HARRIS TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4409
Practice Address - Country:US
Practice Address - Phone:770-815-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC004615101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional