Healthcare Provider Details

I. General information

NPI: 1639864838
Provider Name (Legal Business Name): PEYTON OLIVIA STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 HOUSTON LAKE RD
KATHLEEN GA
31047-5400
US

IV. Provider business mailing address

2490 RIVERSIDE DR STE B
MACON GA
31204-1787
US

V. Phone/Fax

Practice location:
  • Phone: 478-654-2199
  • Fax: 478-633-0577
Mailing address:
  • Phone: 478-633-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number114486
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: