Healthcare Provider Details

I. General information

NPI: 1407837008
Provider Name (Legal Business Name): JERRY ALAN SWENSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MEMORIAL DRIVE ANESTHESIA ASSOCIATES OF DALTON
DALTON GA
30720
US

IV. Provider business mailing address

1936 PINEWOOD CV NW
CLEVELAND TN
37312-1848
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6000
  • Fax:
Mailing address:
  • Phone: 423-476-2583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN61090
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: