Provider Demographics
NPI:1679579643
Name:STEWART, STEVEN O (MD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:O
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HUGH HOWELL RD
Mailing Address - Street 2:STE 220
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-469-0668
Mailing Address - Fax:770-469-0676
Practice Address - Street 1:4500 HUGH HOWELL RD
Practice Address - Street 2:STE 220
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-469-0668
Practice Address - Fax:770-469-0676
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000723863FMedicaid
GA52650560002OtherBC/BS PROVIDER ID
GA1049349OtherFIRST HEALTH
GA87726OtherUHC
GA2031561OtherAETNA PROVIDER NUMBER
GA05011OtherGEORGIA 1ST
GA3891011OtherCIGNA PROVIDER NUMBER
GA1049349OtherFIRST HEALTH
GA000723863FMedicaid