Healthcare Provider Details

I. General information

NPI: 1811514482
Provider Name (Legal Business Name): ESTHER RUTH SWAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2020
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 KIMEL PARK DR STE 101
WINSTON SALEM NC
27103-6185
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-7280
  • Fax: 336-718-7290
Mailing address:
  • Phone: 335-718-7280
  • Fax: 336-718-7290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL83305
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2025-01719
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: