Provider Demographics
NPI:1346318144
Name:SWANN, RALPH WADE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:WADE
Last Name:SWANN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3215 SHRINE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:912-267-1960
Mailing Address - Fax:912-267-1982
Practice Address - Street 1:3215 SHRINE ROAD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-267-1960
Practice Address - Fax:912-267-1982
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAGA21055207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00216664AMedicaid
D41200Medicare UPIN