Provider Demographics
NPI:1508162231
Name:JOHN A. STEWART M.D., P.C.
Entity Type:Organization
Organization Name:JOHN A. STEWART M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-749-5604
Mailing Address - Street 1:122 N 20TH ST
Mailing Address - Street 2:BLDG #25
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5442
Mailing Address - Country:US
Mailing Address - Phone:334-749-5604
Mailing Address - Fax:334-749-3040
Practice Address - Street 1:122 N 20TH ST
Practice Address - Street 2:BLDG #25
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5442
Practice Address - Country:US
Practice Address - Phone:334-749-5604
Practice Address - Fax:334-749-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-07-20
Deactivation Date:2011-06-01
Deactivation Code:
Reactivation Date:2011-07-20
Provider Licenses
StateLicense IDTaxonomies
AL9216261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1265423313Medicaid
AL510 06042OtherBLUE CROSS BLUE SHIELD
AL510 06042OtherBLUE CROSS BLUE SHIELD