MEDICARE: STEWART HARVEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1861115420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEWART HARVEY

Provider Business Mailing Address
First Line	:	1048 SAINT CHARLES AVE NE APT 5
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4274
Country	:	US
Telephone Number	:	904-708-9706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 SAINT CHARLES AVE NE APT 5
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-4274
Country	:	US
Telephone Number	:	904-708-9706
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2022
Last Update Date	:	09/20/2022

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Directions to “ STEWART HARVEY ” Practice Location

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