Provider Demographics
NPI:1447225404
Name:STEWART, FERMIN V (MD)
Entity Type:Individual
Prefix:
First Name:FERMIN
Middle Name:V
Last Name:STEWART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4045 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1217
Mailing Address - Country:US
Mailing Address - Phone:770-495-7116
Mailing Address - Fax:770-495-9410
Practice Address - Street 1:4045 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1253
Practice Address - Country:US
Practice Address - Phone:770-495-7116
Practice Address - Fax:770-495-9410
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA042452207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582630847OtherBEECHSTREET
GA582630847OtherFIRST HEALTH
GA582630847OtherUNITED HEALTHCARE
GA582630847OtherCOVENTRY
GA582630847OtherSTATE MERIT
GA04BDCHMOtherMEDICARE ID
GA582630847OtherUNICARE
GA000710113DMedicaid
GA582630847OtherBCBS
GA582630847OtherTRICARE
GA582630847OtherCIGNA
GA582630847OtherONE HEALTH PLAN
GA5185463OtherAETNA
GA040017870OtherMEDICARE RAILROAD
GA582630847OtherHUMANA
GA582630847OtherPHCS
GA582630847OtherSTATE HEALTH BENEFIT
GA582630847OtherCIGNA