Healthcare Provider Details

I. General information

NPI: 1477256642
Provider Name (Legal Business Name): MARY CATHERINE BARNES STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E CARTER AVE
BLACKSHEAR GA
31516-1561
US

IV. Provider business mailing address

330 CORPORATE WAY STE 200
ORANGE PARK FL
32073-6214
US

V. Phone/Fax

Practice location:
  • Phone: 912-449-4426
  • Fax: 912-449-1059
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number113963
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: