Healthcare Provider Details

I. General information

NPI: 1346287612
Provider Name (Legal Business Name): SWANSBORO FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 MAIN STREET EXT
SWANSBORO NC
28584-9114
US

IV. Provider business mailing address

1106 MAIN STREET EXT
SWANSBORO NC
28584-9114
US

V. Phone/Fax

Practice location:
  • Phone: 910-326-2086
  • Fax: 910-326-2199
Mailing address:
  • Phone: 910-326-2086
  • Fax: 910-326-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RANTON
Title or Position: OWNER
Credential: MD
Phone: 910-326-2086