Healthcare Provider Details

I. General information

NPI: 1851374383
Provider Name (Legal Business Name): JOHN H STEWART IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

840 S WOOD ST MC 958
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 404-752-1000
  • Fax: 404-752-1000
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036147175
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-147175
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number200401335
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: