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General NPI Number Information
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NPI Number | 1922178482
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Entity Type | Organization
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Legal Business Name | RL STEWART DDS PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2998 PANOLA RD SUITE 100
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City | LITHONIA
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State | GA
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Zip | 30038-2312
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Country | US
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Telephone | 770-322-8040
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Fax | 770-322-3024
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Provider Business Mailing Address
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Address Line | 2998 PANOLA RD SUITE 100
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City | LITHONIA
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State | GA
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Zip | 30038-2312
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Country | US
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Telephone | 770-322-8040
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Fax | 770-322-3024
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Authorized Official
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Title or Position | CEO OWNER
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Name | DR. RONNIE L STEWART
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Credential | DDS
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Telephone | 770-322-8040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | GA
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