MEDICARE: AFRICA N 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	174400000X	Specialist	059027	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16BBFBJ	OTHER	GA	MEDICARE

General Provider Information

NPI Number	:	1831159771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFRICA N STEWART MD

Provider Business Mailing Address
First Line	:	1265 HIGHWAY 54 W
Second Line	:	SUITE 410
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4548
Country	:	US
Telephone Number	:	770-997-5714
Fax Number	:	770-997-2810

Provider Business Practice Location Address
First Line	:	1265 HIGHWAY 54 W
Second Line	:	SUITE 410
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4548
Country	:	US
Telephone Number	:	770-997-5714
Fax Number	:	770-997-2810

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/17/2008

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Directions to “ AFRICA N STEWART MD” Practice Location

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