Provider Demographics
NPI:1407029168
Name:SHERRILL B STEWART,MDPC
Entity Type:Organization
Organization Name:SHERRILL B STEWART,MDPC
Other - Org Name:SHERRRILL B STEWART MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-449-2565
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-5009
Mailing Address - Country:US
Mailing Address - Phone:662-449-2565
Mailing Address - Fax:662-449-2566
Practice Address - Street 1:508 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9392
Practice Address - Country:US
Practice Address - Phone:662-286-3280
Practice Address - Fax:662-449-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07460208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011005Medicaid
MS00011005Medicaid