Healthcare Provider Details

I. General information

NPI: 1659618122
Provider Name (Legal Business Name): SUSAN MONTGOMERY SWAFFORD MPH, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MOUNT BOLUS RD
CHAPEL HILL NC
27514-2638
US

IV. Provider business mailing address

25 MOUNT BOLUS RD
CHAPEL HILL NC
27514-2638
US

V. Phone/Fax

Practice location:
  • Phone: 919-395-9960
  • Fax:
Mailing address:
  • Phone: 919-395-9960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL001582
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License NumberL001582
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberL001582
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: