Provider Demographics
NPI:1447520648
Name:STEWART'S DDD, LLC
Entity type:Organization
Organization Name:STEWART'S DDD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JO
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-886-9265
Mailing Address - Street 1:334 E TUGALO ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2130
Mailing Address - Country:US
Mailing Address - Phone:706-886-9265
Mailing Address - Fax:
Practice Address - Street 1:102 N SAGE ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-3678
Practice Address - Country:US
Practice Address - Phone:706-886-3141
Practice Address - Fax:706-886-4000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0063393336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy