Organization
STEWART FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH STEWART (PRACTICE ADMINISTRATOR)
(770) 469-0668
Entity
Organization
Contact information
Practice address
4500 HUGH HOWELL RD, STE 220, TUCKER, GA 30084-4723
(770) 469-0668
Mailing address
4500 HUGH HOWELL RD, STE 220, TUCKER, GA 30084-4723
(770) 469-0668
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
041369
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000723863F
—
GA
01
—
2094167
UNITED HEALTHCARD
GA
01
—
3891011
COVENTRY
GA
01
—
52650560002
BLUE CROSS BLUE SHIELD
GA
01
—
5312576
AETNA
GA
Enumeration date
02/15/2013
Last updated
05/14/2013
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