Provider Demographics
NPI:1730298324
Name:STEWART, DEANNA K (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:K
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-288-5640
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:421 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7236
Practice Address - Country:US
Practice Address - Phone:601-288-5640
Practice Address - Fax:601-261-3507
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13536207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS640507572BFOtherAMERICAN ADMIN GROUP
MS00116693Medicaid
MS1432848OtherUNITED HEALTHCARE
LA1419800Medicaid
MS1432848OtherUNITED HEALTHCARE
MS00116693Medicaid
MS640507572BFOtherAMERICAN ADMIN GROUP