Basic Information
| Provider Information | |||||||||
| NPI: | 1952516007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEWART MILES | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MILES | ||||||||
| OtherFirstName: | DONNA | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1121 JOHNSON FERRY RD | ||||||||
| Address2: | STE 100A | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300685425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705091025 | ||||||||
| FaxNumber: | 7705091884 | ||||||||
| Practice Location | |||||||||
| Address1: | 1121 JOHNSON FERRY RD | ||||||||
| Address2: | STE 100A | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300685425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705091025 | ||||||||
| FaxNumber: | 7705091884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 03/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 000855 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 479278038U | 05 | GA | MEDICAID | 479278038T | 05 | GA | MEDICAID | 479278038S | 05 | GA | MEDICAID | 479278038R | 05 | GA | MEDICAID |