Provider Demographics
NPI:1366700189
Name:AJEBEWANG, SAMMY KINGS
Entity type:Individual
Prefix:
First Name:SAMMY KINGS
Middle Name:
Last Name:AJEBEWANG
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 1:1813 MOUNT PISGAH LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2156
Mailing Address - Country:US
Mailing Address - Phone:240-393-3156
Mailing Address - Fax:
Practice Address - Street 1:1813 MOUNT PISGAH LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2156
Practice Address - Country:US
Practice Address - Phone:240-393-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No172V00000XOther Service ProvidersCommunity Health Worker
No374U00000XNursing Service Related ProvidersHome Health Aide