Healthcare Provider Details

I. General information

NPI: 1174582167
Provider Name (Legal Business Name): SWAPNA VACHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2782 N COBB PKWY
KENNESAW GA
30152-3472
US

IV. Provider business mailing address

2782 N COBB PKWY
KENNESAW GA
30152-3472
US

V. Phone/Fax

Practice location:
  • Phone: 877-993-4321
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5023678
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15564300
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP156882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: