Provider Demographics
NPI:1194930321
Name:STEWART, ASHLEY H (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:H
Last Name:STEWART
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 MEDICAL DRIVE
Mailing Address - Street 2:STE. 506
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-880-7320
Mailing Address - Fax:706-812-2640
Practice Address - Street 1:301 MEDICAL DRIVE
Practice Address - Street 2:STE. 506
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-880-7320
Practice Address - Fax:706-812-2640
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL25147208600000X
GA067169208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510I020018Medicare PIN