Healthcare Provider Details

I. General information

NPI: 1932858461
Provider Name (Legal Business Name): AGATHA LOUISE BERRYHILL STEWART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GOVERNORS DR SW
HUNTSVILLE AL
35801-5123
US

IV. Provider business mailing address

612 S 12TH ST
FORT SMITH AR
72901-4702
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-5511
  • Fax:
Mailing address:
  • Phone: 479-785-2431
  • Fax: 479-785-0732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.51786
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: