Provider Demographics
NPI:1780938985
Name:SCHNEIDER, DEBRA (CPM)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROWARD DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5500
Mailing Address - Country:US
Mailing Address - Phone:770-973-7869
Mailing Address - Fax:
Practice Address - Street 1:2986 ACWORTH DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2310
Practice Address - Country:US
Practice Address - Phone:770-241-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000035176B00000X
175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay