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General NPI Number Information
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NPI Number | 1922679547
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Entity Type | Individual
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Provider Name | MARY CHARLES STEWART CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/06/2021
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 5825 GLENRIDGE DR STE 1-133
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City | ATLANTA
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State | GA
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Zip | 30328-7144
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Country | US
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Telephone | 678-733-9318
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Fax | 404-902-5440
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Provider Business Mailing Address
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Address Line | 286 MIDVALE DR NE
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City | ATLANTA
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State | GA
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Zip | 30342-3327
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Country | US
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Telephone | 256-566-4248
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PCET003364
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License Number State | GA
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