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General NPI Number Information
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NPI Number | 1871674515
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Entity Type | Organization
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Legal Business Name | LAWRENCE C. SWAN, M.D.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 2620 WESTSIDE DR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3605
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Country | US
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Telephone | 423-339-1760
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Fax | 423-559-1483
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Provider Business Mailing Address
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Address Line | 2620 WESTSIDE DR NW
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City | CLEVELAND
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State | TN
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Zip | 37312-3605
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Country | US
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Telephone | 423-339-1760
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Fax | 423-559-1483
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE CARL SWAN
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Credential | M.D.
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Telephone | 423-339-1760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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