Provider Demographics
NPI:1952516007
Name:STEWART MILES, DONNA LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LEIGH
Last Name:STEWART MILES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:LEIGH
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1121 JOHNSON FERRY RD
Mailing Address - Street 2:STE 100A
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5425
Mailing Address - Country:US
Mailing Address - Phone:770-509-1025
Mailing Address - Fax:770-509-1884
Practice Address - Street 1:1121 JOHNSON FERRY RD
Practice Address - Street 2:STE 100A
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5425
Practice Address - Country:US
Practice Address - Phone:770-509-1025
Practice Address - Fax:770-509-1884
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000855207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA479278038UMedicaid
GA479278038TMedicaid
GA479278038SMedicaid
GA479278038RMedicaid
GA479278038SMedicaid
GA479278038UMedicaid