MEDICARE: MS. DANISHA STEWART FNP

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	363LF0000X	Family Nurse Practitioner	RN207277	GA
2	363L00000X	Nurse Practitioner	RN207277	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538623939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANISHA STEWART FNP

Provider Business Mailing Address
First Line	:	4328 PARK GATE DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-7055
Country	:	US
Telephone Number	:	770-624-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 SPECTRUM CIR SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8479
Country	:	US
Telephone Number	:	678-921-2706
Fax Number	:	877-850-1971

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

Provider Enumeration Date	:	01/30/2019
Last Update Date	:	10/25/2021

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