Provider Demographics
NPI:1437375763
Name:STEWART, DEREX L (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREX
Middle Name:L
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 1:149 GOLF TERRACE DR.
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2172
Mailing Address - Country:US
Mailing Address - Phone:404-915-1350
Mailing Address - Fax:672-272-0210
Practice Address - Street 1:149 GOLF TERRACE DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6363
Practice Address - Country:US
Practice Address - Phone:404-915-1350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine