Provider Demographics
NPI:1073541678
Name:SWAYZE, AVA M (DO)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:M
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4997
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27204-4997
Mailing Address - Country:US
Mailing Address - Phone:336-674-3415
Mailing Address - Fax:336-674-3458
Practice Address - Street 1:364 WHITE OAK ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5434
Practice Address - Country:US
Practice Address - Phone:336-830-9192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3153207R00000X
NC2007-00138208M00000X
MEDO2633208M00000X
NC200700138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00186070OtherRR MEDICARE
TX146821702Medicaid
TX8P6312OtherBC/BS
TXH51304Medicare UPIN
TX146821702Medicaid