Provider Demographics
NPI:1174285357
Name:SWIFT, MAGGIE WALKER (RD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:WALKER
Last Name:SWIFT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 RIVERMONT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5991
Mailing Address - Country:US
Mailing Address - Phone:931-801-8902
Mailing Address - Fax:
Practice Address - Street 1:424 RIVERMONT DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5991
Practice Address - Country:US
Practice Address - Phone:931-801-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4120133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered