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General NPI Number Information
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NPI Number | 1023294196
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Entity Type | Organization
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Legal Business Name | SUBURBAN MEDICAL ASSOCI
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 3005 OLD ALABAMA RD SUITE 230
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City | ALPHARETTA
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State | GA
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Zip | 30022-8594
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Country | US
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Telephone | 770-740-8550
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Fax | 770-740-9338
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Provider Business Mailing Address
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Address Line | 3005 OLD ALABAMA RD SUITE 230
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City | ALPHARETTA
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State | GA
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Zip | 30022-8594
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Country | US
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Telephone | 770-740-8550
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Fax | 770-740-9338
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JAMES LAMAR STEWART
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Credential | MD
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Telephone | 770-740-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 033205
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License Number State | GA
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