Provider Demographics
NPI:1093012957
Name:STEWART, DANA MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MICHELLE
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:855 CURTIS PKWY SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-3688
Practice Address - Country:US
Practice Address - Phone:706-624-5190
Practice Address - Fax:706-876-6601
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145278363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107366DMedicaid
GA202I501515Medicare PIN