Provider Demographics
NPI:1518935543
Name:SCHMIDT, EDWIN LIONEL JR (PA)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:LIONEL
Last Name:SCHMIDT
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:8 RICHLAND MEDICAL PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8004
Practice Address - Country:US
Practice Address - Phone:803-765-0871
Practice Address - Fax:803-765-9215
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC886363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0237PAMedicaid
SC5776Medicare PIN
SCP991165776Medicare PIN