Healthcare Provider Details

I. General information

NPI: 1740488469
Provider Name (Legal Business Name): TERRELL J. SWANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: T. JOHN SWANSON M.D.

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 SALISBURY RD
JACKSONVILLE FL
32216-6123
US

IV. Provider business mailing address

10961 BURNT MILL RD #828
JACKSONVILLE FL
32256-4654
US

V. Phone/Fax

Practice location:
  • Phone: 904-641-6628
  • Fax:
Mailing address:
  • Phone: 904-333-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number65801
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25845
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME111251
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: