Healthcare Provider Details

I. General information

NPI: 1679579643
Provider Name (Legal Business Name): STEVEN O. STEWART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 HUGH HOWELL RD STE 220
TUCKER GA
30084
US

IV. Provider business mailing address

4500 HUGH HOWELL RD STE 220
TUCKER GA
30084
US

V. Phone/Fax

Practice location:
  • Phone: 770-469-0668
  • Fax: 770-469-0676
Mailing address:
  • Phone: 770-469-0668
  • Fax: 770-469-0676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number041369
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: