Healthcare Provider Details

I. General information

NPI: 1407029168
Provider Name (Legal Business Name): SHERRILL B STEWART,MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 ALCORN DR
CORINTH MS
38834-9392
US

IV. Provider business mailing address

PO BOX 1009
HERNANDO MS
38632-5009
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-3280
  • Fax: 662-449-2566
Mailing address:
  • Phone: 662-449-2565
  • Fax: 662-449-2566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number07460
License Number StateMS

VIII. Authorized Official

Name: MRS. CAROL LYNN COWAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 662-449-2565