Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 76965 | GA |
Y | 111NI0900X | Internist | 76965 | GA |
N | 207R00000X | Internist | LP02817 | RI |
N | 111NI0900X | Internist | LP02817 | RI |
N | 208D00000X | General Practice Physician | 76965 | GA |
NPI | 1003253162 |
---|---|
Provider Name | Dr. Earl Stewart JR. |
First Address | Atlanta, GA 30339-5743 |
Second Address | Atlanta, GA 30339-5743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2013 |
Last Update Date | 22/05/2020 |