Healthcare Provider Details

I. General information

NPI: 1700727351
Provider Name (Legal Business Name): BERKLEY KEITH STEWART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PROFESSIONAL PL STE 107
CARROLLTON GA
30117-3827
US

IV. Provider business mailing address

1900 THE EXCHANGE SE STE 600
ATLANTA GA
30339-2050
US

V. Phone/Fax

Practice location:
  • Phone: 770-291-8987
  • Fax:
Mailing address:
  • Phone: 770-291-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP288832
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: