Healthcare Provider Details

I. General information

NPI: 1922026046
Provider Name (Legal Business Name): THOMAS K STEWART P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 N MAIN ST
MARION SC
29571-2008
US

IV. Provider business mailing address

1205 N MAIN ST
MARION SC
29571-2008
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-0760
  • Fax: 843-423-8138
Mailing address:
  • Phone: 843-423-0760
  • Fax: 843-423-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA212
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: