Healthcare Provider Details

I. General information

NPI: 1134712300
Provider Name (Legal Business Name): SARAH MARIE SWISHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WATSON BLVD
WARNER ROBINS GA
31093-3431
US

IV. Provider business mailing address

248 CHAMBERS ROAD
MACON GA
31217
US

V. Phone/Fax

Practice location:
  • Phone: 478-922-4281
  • Fax:
Mailing address:
  • Phone: 540-460-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11720
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: