Provider Demographics
NPI:1962970616
Name:STUART, GEORGE ELDER JR (PT, DPT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ELDER
Last Name:STUART
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LEXINGTON DR STE H
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6646
Mailing Address - Country:US
Mailing Address - Phone:601-910-7300
Mailing Address - Fax:601-910-7071
Practice Address - Street 1:105 LEXINGTON DR STE H
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6646
Practice Address - Country:US
Practice Address - Phone:601-910-7300
Practice Address - Fax:601-910-7071
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-10
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS5769261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy