Provider Demographics
NPI:1134314032
Name:STEWART, HEATHER DENISE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DENISE
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 WATERS AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6267
Mailing Address - Country:US
Mailing Address - Phone:912-350-6543
Mailing Address - Fax:912-350-7690
Practice Address - Street 1:4750 WATERS AVE STE 108
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6267
Practice Address - Country:US
Practice Address - Phone:912-350-6543
Practice Address - Fax:912-350-7690
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC373572080P0210X, 208000000X
NC2008-005572080P0210X, 2080P0210X
GA841832080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1134314032Medicaid
SC373571Medicaid
SCSC38372389Medicare PIN
NC1134314032Medicaid
NCNC8125AMedicare PIN