=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568967081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERNICE R SWAIN DO PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2018
-----------------------------------------------------
Last Update Date | 03/27/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2424 DANVILLE RD SW STE L
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-341-0043
-----------------------------------------------------
Fax | 256-341-0043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2424 DANVILLE RD SW STE L
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35603-4219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-341-0043
-----------------------------------------------------
Fax | 256-341-0043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. BERNICE RENEE SWAIN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 256-341-0043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------