Provider Demographics
NPI:1952558058
Name:STUART, TIMOTHY (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 N LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29341-2026
Mailing Address - Country:US
Mailing Address - Phone:864-488-1333
Mailing Address - Fax:864-488-3004
Practice Address - Street 1:1307 N LOGAN ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29341-2026
Practice Address - Country:US
Practice Address - Phone:864-488-1333
Practice Address - Fax:864-488-3004
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
SC984363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00911625OtherRAILROAD MEDICARE
SCSCE4916121OtherMEDICARE PIN
SCSCE4916084OtherMEDICARE PIN
SC0512PAMedicaid
SCP00911625OtherRAILROAD MEDICARE