Provider Demographics
NPI:1164414256
Name:STEWART, GARY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WAYNE
Last Name:STEWART
Suffix:
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 1:105 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253
Mailing Address - Country:US
Mailing Address - Phone:770-506-4119
Mailing Address - Fax:770-506-4145
Practice Address - Street 1:105 REGENCY PARK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253
Practice Address - Country:US
Practice Address - Phone:770-506-4119
Practice Address - Fax:770-506-4145
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057845207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA084589634BMedicaid
GA084589634AMedicaid
GA084589634CMedicaid
GA084589634DMedicaid
GA20NCCNPMedicare PIN
GA084589634BMedicaid