Provider Demographics
NPI:1134507171
Name:STEWART, RODRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:RODRICK
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 AUBURN AVE NE STE 156
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1976
Mailing Address - Country:US
Mailing Address - Phone:404-888-0228
Mailing Address - Fax:404-888-0552
Practice Address - Street 1:659 AUBURN AVE NE STE 156
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1976
Practice Address - Country:US
Practice Address - Phone:404-888-0228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine