Provider Demographics
NPI:1154189140
Name:STEWART, JAMIR
Entity type:Individual
Prefix:
First Name:JAMIR
Middle Name:
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:STEWART.JAMAIR@OUTLOOK.COM
Mailing Address - Street 2:112 REGENCY CT.
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-7024
Mailing Address - Country:US
Mailing Address - Phone:478-737-3480
Mailing Address - Fax:
Practice Address - Street 1:STEWART.JAMAIR@OUTLOOK.COM
Practice Address - Street 2:112 REGENCY CT.
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-7024
Practice Address - Country:US
Practice Address - Phone:478-737-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1068938106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician