Healthcare Provider Details

I. General information

NPI: 1992389746
Provider Name (Legal Business Name): GEORGE SWEARINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HYDE ST
SAN FRANCISCO CA
94109-5996
US

IV. Provider business mailing address

14 ESTACADA RD
SANTA FE NM
87508-8758
US

V. Phone/Fax

Practice location:
  • Phone: 505-316-2019
  • Fax:
Mailing address:
  • Phone: 505-699-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number013283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: