Healthcare Provider Details

I. General information

NPI: 1336956630
Provider Name (Legal Business Name): SARA MUNROE STEWART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE BLDG C
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

4372 STOCKTON CT
MARIETTA GA
30066-2138
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1900
  • Fax:
Mailing address:
  • Phone: 404-784-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberAPRN-NP214082
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: