Healthcare Provider Details

I. General information

NPI: 1427251412
Provider Name (Legal Business Name): JOHN GRAYSON STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 ST. SEBASTIAN WAY
AUGUSTA GA
30912-2615
US

IV. Provider business mailing address

P.O. BOX 2825
AUGUSTA GA
30914-2825
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-2971
  • Fax: 706-721-1937
Mailing address:
  • Phone: 706-737-4575
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number65901
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: