Provider Demographics
NPI:1194220236
Name:SWAFFORD, WILLIAM STACY (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STACY
Last Name:SWAFFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 MATHERLY ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-1001
Mailing Address - Country:US
Mailing Address - Phone:931-484-2727
Mailing Address - Fax:931-484-1670
Practice Address - Street 1:181 MATHERLY ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555
Practice Address - Country:US
Practice Address - Phone:931-484-2727
Practice Address - Fax:931-484-1670
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000003530208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine