MEDICARE: DR. THOMAS RUSSELL STEWART MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician	31331	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52024358-005	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1033142856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS RUSSELL STEWART MD

Provider Business Mailing Address
First Line	:	PO BOX 1038
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31902-1038
Country	:	US
Telephone Number	:	706-653-8556
Fax Number	:	706-320-8853

Provider Business Practice Location Address
First Line	:	1900 10TH AVE
Second Line	:	SUITE 200
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3600
Country	:	US
Telephone Number	:	706-653-8556
Fax Number	:	706-653-9778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/03/2017

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