Provider Demographics
NPI:1538623939
Name:STEWART, DANISHA (FNP)
Entity type:Individual
Prefix:MS
First Name:DANISHA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 PARK GATE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-7055
Mailing Address - Country:US
Mailing Address - Phone:770-624-0984
Mailing Address - Fax:
Practice Address - Street 1:1950 SPECTRUM CIR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8479
Practice Address - Country:US
Practice Address - Phone:678-921-2706
Practice Address - Fax:877-850-1971
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN207277363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN207277Medicaid