Provider Demographics
NPI:1487887329
Name:ANDRE' C. SCHOEFFLER, M.D., P.C.
Entity type:Organization
Organization Name:ANDRE' C. SCHOEFFLER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-781-1966
Mailing Address - Street 1:401 PAT HARALSON DRIVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512
Mailing Address - Country:US
Mailing Address - Phone:706-781-1966
Mailing Address - Fax:706-781-1968
Practice Address - Street 1:401 PAT HARALSON DRIVE
Practice Address - Street 2:UNIT 2
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-781-1966
Practice Address - Fax:706-781-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00946393AMedicaid
GA00946393AMedicaid
08BBWLVMedicare PIN