Healthcare Provider Details

I. General information

NPI: 1104433218
Provider Name (Legal Business Name): VERONICA A STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3187 SABLE RUN RD
ATLANTA GA
30349-8828
US

IV. Provider business mailing address

3187 SABLE RUN RD
ATLANTA GA
30349-8828
US

V. Phone/Fax

Practice location:
  • Phone: 904-545-5010
  • Fax:
Mailing address:
  • Phone: 904-545-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberCN0030071038
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: