Healthcare Provider Details

I. General information

NPI: 1568802023
Provider Name (Legal Business Name): NATHANIEL STEVEN SWANSON PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3204 PEACH ORCHARD RD
AUGUSTA GA
30906-4862
US

IV. Provider business mailing address

453 SWEET APPLE LN
BUFORD GA
30518-1667
US

V. Phone/Fax

Practice location:
  • Phone: 706-796-7240
  • Fax:
Mailing address:
  • Phone: 770-633-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH027186
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: