Healthcare Provider Details

I. General information

NPI: 1003320433
Provider Name (Legal Business Name): KRYSTLE WILLIAMS SWAIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 OLD JEFFERSON RD STE 600
ATHENS GA
30607-1463
US

IV. Provider business mailing address

3320 OLD JEFFERSON RD BLDG 800
ATHENS GA
30607-1400
US

V. Phone/Fax

Practice location:
  • Phone: 762-356-4933
  • Fax: 762-356-4034
Mailing address:
  • Phone: 706-353-2990
  • Fax: 706-353-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8576
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number8576
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: