1477540565 NPI number — ANTHONY L SWAFFORD CRNA

Table of content: ANTHONY L SWAFFORD CRNA (NPI 1477540565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477540565 NPI number — ANTHONY L SWAFFORD CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAFFORD
Provider First Name:
ANTHONY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477540565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 102186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30368-2186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-919-1190
Provider Business Mailing Address Fax Number:
706-737-2271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 TURNER MCCALL BLVD SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30165-5630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-802-2000
Provider Business Practice Location Address Fax Number:
706-233-9846
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  RN032641 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000498781D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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