Healthcare Provider Details

I. General information

NPI: 1447225404
Provider Name (Legal Business Name): FERMIN V. G. STEWART M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 JOHNS CREEK PKWY SUITE C
SUWANEE GA
30024-1253
US

IV. Provider business mailing address

4045 JOHNS CREEK PKWY STE C
JOHNS CREEK GA
30024-1218
US

V. Phone/Fax

Practice location:
  • Phone: 770-495-7116
  • Fax: 770-495-9410
Mailing address:
  • Phone: 770-495-7116
  • Fax: 770-495-9410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number97597
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number042452
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: