Healthcare Provider Details

I. General information

NPI: 1003046129
Provider Name (Legal Business Name): SARA E. SWANN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NOMORA DR
DANIELSVILLE GA
30633-7058
US

IV. Provider business mailing address

1450 B BARNETT SHOALS ROAD
ATHENS GA
30605-2748
US

V. Phone/Fax

Practice location:
  • Phone: 706-795-9588
  • Fax: 706-795-0969
Mailing address:
  • Phone: 706-543-6443
  • Fax: 706-543-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN181114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: