Provider Demographics
NPI:1184017576
Name:STEWART, TAMU T (CNA)
Entity Type:Individual
Prefix:MISS
First Name:TAMU
Middle Name:T
Last Name:STEWART
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CLUBHOUSE DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5062
Mailing Address - Country:US
Mailing Address - Phone:678-949-1629
Mailing Address - Fax:
Practice Address - Street 1:152 CLUBHOUSE DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5062
Practice Address - Country:US
Practice Address - Phone:678-949-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030009290376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide