Provider Demographics
NPI:1164920229
Name:STEWART, MARA (MEDICAL BILLING)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:MEDICAL BILLING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 OLD GREYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-2956
Mailing Address - Country:US
Mailing Address - Phone:678-469-6790
Mailing Address - Fax:404-796-7830
Practice Address - Street 1:1231 OLD GREYSTONE DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-2956
Practice Address - Country:US
Practice Address - Phone:678-469-6790
Practice Address - Fax:404-796-7830
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA36551219171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA821925568OtherMEDICAL BILLER