Individual
THOMAS K STEWART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1205 N MAIN ST, MARION, SC 29571-2008
(843) 423-0760
(843) 423-8138
Mailing address
1205 N MAIN ST, MARION, SC 29571-2008
(843) 423-0760
(843) 423-8138
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A212
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1089PA
—
SC
01
—
GP5462
MEDICAID GROUP
SC
Enumeration date
07/17/2006
Last updated
10/15/2020
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