Provider Demographics
NPI:1184780934
Name:OSWALD, STEPHEN GARY (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GARY
Last Name:OSWALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 KESTWICK DR W
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1690
Mailing Address - Country:US
Mailing Address - Phone:706-364-5074
Mailing Address - Fax:
Practice Address - Street 1:235 KESTWICK DR W
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1690
Practice Address - Country:US
Practice Address - Phone:706-364-5074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053351207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine