Provider Demographics
NPI:1164259578
Name:STEWART, ADONNIS JAMAAL
Entity type:Individual
Prefix:
First Name:ADONNIS
Middle Name:JAMAAL
Last Name:STEWART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8212 BROOKTREE ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2928
Mailing Address - Country:US
Mailing Address - Phone:202-834-8172
Mailing Address - Fax:
Practice Address - Street 1:8212 BROOKTREE ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2928
Practice Address - Country:US
Practice Address - Phone:202-834-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities