Provider Demographics
NPI:1952957714
Name:STEWART, MELISA
Entity type:Individual
Prefix:DR
First Name:MELISA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISA
Other - Middle Name:
Other - Last Name:RATHBURN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5555 PEACHTREE DUNWOODY RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1712
Mailing Address - Country:US
Mailing Address - Phone:404-255-5454
Mailing Address - Fax:
Practice Address - Street 1:5555 PEACHTREE DUNWOODY RD STE 301
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1712
Practice Address - Country:US
Practice Address - Phone:404-255-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics