Provider Demographics
NPI:1447340211
Name:SCHULTZ, AGNES S (MD)
Entity type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:S
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CHESTERFIELD HWY
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-3001
Mailing Address - Country:US
Mailing Address - Phone:843-537-1811
Mailing Address - Fax:843-537-1802
Practice Address - Street 1:119 CHESTERFIELD HIGHWAY
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520
Practice Address - Country:US
Practice Address - Phone:843-537-1811
Practice Address - Fax:843-537-1802
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17373208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT15597Medicaid
F84867Medicare UPIN
SCT15597Medicaid