MEDICARE: JADA SWANSON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN277490	GA

General Provider Information

NPI Number	:	1033998323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA SWANSON NP

Provider Business Mailing Address
First Line	:	5462 WHITTLESEY BLVD APT 1017
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3049
Country	:	US
Telephone Number	:	229-314-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 18TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1724
Country	:	US
Telephone Number	:	706-507-3747
Fax Number	:	706-507-3638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	12/04/2023

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