Provider Demographics
NPI:1003253162
Name:STEWART, EARL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:
Last Name:STEWART
Suffix:JR
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 1:2850 PACES FERRY RD SE STE 460
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5743
Mailing Address - Country:US
Mailing Address - Phone:678-556-4950
Mailing Address - Fax:
Practice Address - Street 1:2850 PACES FERRY RD SE STE 460
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5743
Practice Address - Country:US
Practice Address - Phone:678-556-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02817207R00000X
GA76965208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice