Provider Demographics
NPI:1558583021
Name:LITTLE, STEWART CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:CHARLES
Last Name:LITTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1107 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:706-272-3512
Practice Address - Street 1:2358 LIFESTYLE WAY STE 212
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2291
Practice Address - Country:US
Practice Address - Phone:423-521-1100
Practice Address - Fax:423-521-1200
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN553892086S0122X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027092Medicaid
LA1060631Medicaid