MEDICARE: DR. GARY WILLIAM SWAIN JR. M.D.

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	208600000X	Surgery Physician	93789	GA
2	208600000X	Surgery Physician	258894	NY

General Provider Information

NPI Number	:	1699933663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY WILLIAM SWAIN JR. M.D.

Provider Business Mailing Address
First Line	:	980 JOHNSON FY RD NE STE 880
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1609
Country	:	US
Telephone Number	:	404-255-8304
Fax Number	:	404-256-4578

Provider Business Practice Location Address
First Line	:	980 JOHNSON FY RD NE STE 880
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1609
Country	:	US
Telephone Number	:	404-255-8304
Fax Number	:	404-256-4578

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	12/19/2022

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