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General NPI Number Information
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NPI Number | 1578919569
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Entity Type | Organization
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Legal Business Name | THE SWINFORD CLINIC, LLC
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 12 S ERWIN ST SUITE 5
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3560
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Country | US
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Telephone | 404-985-1835
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Fax |
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Provider Business Mailing Address
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Address Line | 12 S ERWIN ST SUITE 5
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City | CARTERSVILLE
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State | GA
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Zip | 30120-3560
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Country | US
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Telephone | 404-985-1835
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMBER MARIE SWINFORD
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Credential | LMT
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Telephone | 404-985-1835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | MT011091
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License Number State | GA
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