Healthcare Provider Details

I. General information

NPI: 1629980792
Provider Name (Legal Business Name): PATRICIA L SWAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 WATSON BLVD
WARNER ROBINS GA
31093-8041
US

IV. Provider business mailing address

254 MORGAN RANCH CIR
BONAIRE GA
31005-3637
US

V. Phone/Fax

Practice location:
  • Phone: 478-971-4949
  • Fax: 478-971-7080
Mailing address:
  • Phone: 478-971-4949
  • Fax: 478-971-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberLDO001652
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: