Healthcare Provider Details

I. General information

NPI: 1720143696
Provider Name (Legal Business Name): GILLIAN JOSEPHINE STUART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEADOWS PKWY
VIDALIA GA
30474-8759
US

IV. Provider business mailing address

620 W DUE WEST AVE APT 129
MADISON TN
37115-3079
US

V. Phone/Fax

Practice location:
  • Phone: 912-535-5555
  • Fax:
Mailing address:
  • Phone: 254-289-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number110343
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberN8463
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101250864
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberTP913
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number40681
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN8463
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: