Provider Demographics
NPI:1114913514
Name:SWANGER, RUSSELL D (DO)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:D
Last Name:SWANGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 RHODES HILL DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4951
Mailing Address - Country:US
Mailing Address - Phone:706-737-3948
Mailing Address - Fax:
Practice Address - Street 1:2806 HILLCREEK DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6484
Practice Address - Country:US
Practice Address - Phone:706-863-0200
Practice Address - Fax:706-863-4695
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1128207V00000X
GA038629207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00638272BMedicaid
NC147GGOtherBCBS
NC5908040Medicaid
SCG38629OtherMEDICAID
SCG38629Medicaid
SCG38629OtherMEDICAID