Healthcare Provider Details

I. General information

NPI: 1841654563
Provider Name (Legal Business Name): JONATHAN SWANSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

1059 BALDWIN LN
BIRMINGHAM AL
35242-7078
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8865
  • Fax:
Mailing address:
  • Phone: 770-298-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number80409
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: