Provider Demographics
NPI:1306112248
Name:STEWART, ELIZABETH WINDOM (NP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:WINDOM
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:WINDOM
Other - Last Name:PALMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11935 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1909
Mailing Address - Country:US
Mailing Address - Phone:912-961-5726
Mailing Address - Fax:912-961-0679
Practice Address - Street 1:300 BULL ST STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401
Practice Address - Country:US
Practice Address - Phone:912-350-2600
Practice Address - Fax:912-232-1148
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107561363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003124271AMedicaid
GA691336OtherWELLCARE
GAP01063068OtherRAILROAD MEDICARE
GA202I501071Medicare PIN