Individual
DR. WALTER STEWART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
208 S GREENWOOD ST, LAGRANGE, GA 30240-3120
(706) 882-7711
(706) 882-7713
Mailing address
208 SOUTH GREENWOOD ST., LAGRANGE, GA 30240
(706) 882-7711
(706) 882-7713
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
7648
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100747
PEACHSTATE PROVIDER #
GA
01
—
9179576
WELLCARE PROVIDER #
GA
Enumeration date
11/13/2006
Last updated
07/09/2007
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