Healthcare Provider Details

I. General information

NPI: 1881031441
Provider Name (Legal Business Name): JOSHUA BRYAN SWINDLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1
FPO AP
96350-1200
US

IV. Provider business mailing address

573 HUNT LN
LAFAYETTE TN
37083-3506
US

V. Phone/Fax

Practice location:
  • Phone: 615-388-1671
  • Fax:
Mailing address:
  • Phone: 615-388-1671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: