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General NPI Number Information
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NPI Number | 1932565694
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Entity Type | Organization
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Legal Business Name | SWACK MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 2400 WAYNE MEMORIAL DR SUITE C
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City | GOLDSBORO
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State | NC
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Zip | 27534-1789
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Country | US
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Telephone | 724-691-7912
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Fax | 919-988-9676
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Provider Business Mailing Address
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Address Line | 2400 WAYNE MEMORIAL DR SUITE C
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City | GOLDSBORO
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State | NC
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Zip | 27534-1789
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Country | US
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Telephone | 919-988-9674
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Fax | 919-988-9676
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RANDY LEE SWACKHAMMER
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Credential | MD
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Telephone | 919-988-9674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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