1194728139 NPI number — MRS. SUSAN J STEWART P.A.-C

Table of content: MRS. SUSAN J STEWART P.A.-C (NPI 1194728139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194728139 NPI number — MRS. SUSAN J STEWART P.A.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEWART
Provider First Name:
SUSAN
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWEENEY
Provider Other First Name:
SUSAN
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194728139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 PEACHTREE RD NE
Provider Second Line Business Mailing Address:
STE 640
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30309-1423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-355-3161
Provider Business Mailing Address Fax Number:
404-355-1353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 PEACHTREE RD NE
Provider Second Line Business Practice Location Address:
STE 640
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-355-3161
Provider Business Practice Location Address Fax Number:
404-355-1353
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  003587 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00211373D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".