Provider Demographics
NPI:1659539328
Name:LORI SCHWAM, M.D., LLC
Entity type:Organization
Organization Name:LORI SCHWAM, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-836-9379
Mailing Address - Street 1:PO BOX 211957
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30917-1957
Mailing Address - Country:US
Mailing Address - Phone:706-836-9379
Mailing Address - Fax:706-228-4814
Practice Address - Street 1:4424 COLUMBIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-4565
Practice Address - Country:US
Practice Address - Phone:706-993-3187
Practice Address - Fax:706-210-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA239596957AMedicaid
GA239596957AMedicaid
GAH77637Medicare UPIN