Healthcare Provider Details

I. General information

NPI: 1174188544
Provider Name (Legal Business Name): PAUL HOUSTON STEWART PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11603 MIDLOTHIAN TPKE
MIDLOTHIAN VA
23113-2620
US

IV. Provider business mailing address

PO BOX 3548
AUGUSTA GA
30914-3548
US

V. Phone/Fax

Practice location:
  • Phone: 804-378-3739
  • Fax:
Mailing address:
  • Phone: 706-863-9595
  • Fax: 706-447-7184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112732
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9635
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8224
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: