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General NPI Number Information
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NPI Number | 1184964967
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Entity Type | Organization
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Legal Business Name | STEWART FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 4500 HUGH HOWELL RD STE 220
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City | TUCKER
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State | GA
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Zip | 30084-4723
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Country | US
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Telephone | 770-469-0668
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 HUGH HOWELL RD STE 220
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City | TUCKER
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State | GA
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Zip | 30084-4723
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Country | US
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Telephone | 770-469-0668
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | DEBORAH STEWART
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Credential |
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Telephone | 770-469-0668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 041369
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License Number State | GA
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