Healthcare Provider Details

I. General information

NPI: 1528546652
Provider Name (Legal Business Name): PAMELA LYNN STEWART FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 DRAYTON ST
SAVANNAH GA
31401-7526
US

IV. Provider business mailing address

1602 DRAYTON ST
SAVANNAH GA
31401-7526
US

V. Phone/Fax

Practice location:
  • Phone: 912-651-2587
  • Fax: 912-651-2588
Mailing address:
  • Phone: 912-651-2587
  • Fax: 912-651-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN130372
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN130372
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: