Provider Demographics
NPI:1447376116
Name:STEWART, MERRILEE L (MSW)
Entity type:Individual
Prefix:MS
First Name:MERRILEE
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:MERRILEE
Other - Middle Name:ANN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:445 N. SESSIONS ST NW
Mailing Address - Street 2:#2106
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1364
Mailing Address - Country:US
Mailing Address - Phone:770-432-0660
Mailing Address - Fax:770-432-6787
Practice Address - Street 1:1260 CONCORD RD SE
Practice Address - Street 2:STE 101
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-5306
Practice Address - Country:US
Practice Address - Phone:770-432-0660
Practice Address - Fax:770-432-6787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW008471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52066479 01OtherBCBS
007761OtherVALUEOPTIONS
152516060825OtherHUMANA
GAQ34139Medicare UPIN
GA80BBFWWMedicare ID - Type Unspecified