Provider Demographics
NPI:1447502224
Name:STEWART, MARTHA LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:LYNN
Last Name:STEWART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3042 ARCHWAY CIR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-8074
Mailing Address - Country:US
Mailing Address - Phone:678-960-4322
Mailing Address - Fax:
Practice Address - Street 1:3042 ARCHWAY CIR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8074
Practice Address - Country:US
Practice Address - Phone:678-960-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN218645163W00000X, 363L00000X, 363LA2200X
IN28131911A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health