Healthcare Provider Details

I. General information

NPI: 1669996807
Provider Name (Legal Business Name): SUSANNAH STEWART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 E GARRISON BLVD
GASTONIA NC
28054-5127
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-3848
  • Fax: 704-854-3086
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5010710
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: