Provider Demographics
NPI:1528555182
Name:STEWART PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:STEWART PSYCHIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-570-1888
Mailing Address - Street 1:8316 MACON TER STE 103
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-8505
Mailing Address - Country:US
Mailing Address - Phone:901-791-2892
Mailing Address - Fax:901-791-4872
Practice Address - Street 1:8316 MACON TER STE 103
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-8505
Practice Address - Country:US
Practice Address - Phone:901-791-2892
Practice Address - Fax:901-791-4872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21943163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN21943OtherLICENSE 21943