Provider Demographics
NPI:1255309100
Name:STEWART, JAMES ALFRED (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALFRED
Last Name:STEWART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10080 MEDLOCK BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2010
Mailing Address - Country:US
Mailing Address - Phone:770-623-3931
Mailing Address - Fax:770-623-3937
Practice Address - Street 1:10080 MEDLOCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2010
Practice Address - Country:US
Practice Address - Phone:770-623-3931
Practice Address - Fax:770-623-3937
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001639152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582000939AMedicaid
GA582000939AMedicaid
GA41CFSWMedicare ID - Type Unspecified