Healthcare Provider Details

I. General information

NPI: 1770962607
Provider Name (Legal Business Name): SARA ANN SWANTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6237 CAROLINA COMMONS DR STE 101
INDIAN LAND SC
29707-4511
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 803-548-9393
  • Fax: 803-548-9590
Mailing address:
  • Phone: 844-266-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number208173
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: