Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 31331 | GA |
NPI | 1033142856 |
---|---|
Provider Name | Dr. Thomas Russell Stewart |
First Address | Columbus, GA 31902-1038 |
Second Address | Columbus, GA 31901-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 03/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
52024358-005 | BCBS (01) | GA |
D42076 | (02) | GA |