Healthcare Provider Details

I. General information

NPI: 1134507171
Provider Name (Legal Business Name): RODRICK STEWART D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 AUBURN AVE NE STE 156
ATLANTA GA
30312-1976
US

IV. Provider business mailing address

659 AUBURN AVE NE STE 156
ATLANTA GA
30312-1976
US

V. Phone/Fax

Practice location:
  • Phone: 404-888-0228
  • Fax:
Mailing address:
  • Phone: 404-888-0228
  • Fax: 404-888-0552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83320
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: