Healthcare Provider Details

I. General information

NPI: 1700646445
Provider Name (Legal Business Name): RENA STEWART DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 LAKE XING
STONE MOUNTAIN GA
30087-6340
US

IV. Provider business mailing address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax: 404-329-2237
Mailing address:
  • Phone: 678-205-7281
  • Fax: 404-329-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN141497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: