Provider Demographics
NPI:1982735395
Name:STEWART, MARC COLE (PT)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:COLE
Last Name:STEWART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1230
Mailing Address - Country:US
Mailing Address - Phone:770-622-5344
Mailing Address - Fax:
Practice Address - Street 1:4060 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE H
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1230
Practice Address - Country:US
Practice Address - Phone:770-622-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006322225100000X
GAPT006322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT006322OtherPT LICENSE
GA65BBCHQMedicare PIN