Healthcare Provider Details

I. General information

NPI: 1043548373
Provider Name (Legal Business Name): COLIN EXALL STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1256 BRIARCLIFF RD NE
ATLANTA GA
30306-2636
US

IV. Provider business mailing address

1256 BRIARCLIFF RD NE
ATLANTA GA
30306-2636
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-3886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number066823
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: