Provider Demographics
NPI:1811328222
Name:STEWART, RICHARD EMORY (ATC)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:EMORY
Last Name:STEWART
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 W VILLAGE WAY SE
Mailing Address - Street 2:UNIT 3106
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-9219
Mailing Address - Country:US
Mailing Address - Phone:540-808-6567
Mailing Address - Fax:404-894-0695
Practice Address - Street 1:150 BOBBY DODD WAY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332-2500
Practice Address - Country:US
Practice Address - Phone:404-894-2529
Practice Address - Fax:404-894-0695
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014982255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer