Provider Demographics
NPI:1487276580
Name:SCHULTE, JOHN DAVISON (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVISON
Last Name:SCHULTE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 MEDCOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9167
Mailing Address - Country:US
Mailing Address - Phone:843-572-2663
Mailing Address - Fax:
Practice Address - Street 1:7 S ALLIANCE DR STE 111B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7296
Practice Address - Country:US
Practice Address - Phone:843-971-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant