Provider Demographics
NPI:1538374376
Name:SNYDER, EARL J (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:J
Last Name:SNYDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WESTPARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1575
Mailing Address - Country:US
Mailing Address - Phone:770-487-0029
Mailing Address - Fax:770-692-0116
Practice Address - Street 1:525 WESTPARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1575
Practice Address - Country:US
Practice Address - Phone:770-487-0029
Practice Address - Fax:770-692-0116
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055703208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
100791Medicare PIN
C29889Medicare UPIN