Provider Demographics
NPI:1467402321
Name:SWAN, LAWRENCE C (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:SWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 WESTSIDE DR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-3605
Mailing Address - Country:US
Mailing Address - Phone:423-339-1760
Mailing Address - Fax:423-559-1483
Practice Address - Street 1:2620 WESTSIDE DR NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-3605
Practice Address - Country:US
Practice Address - Phone:423-339-1760
Practice Address - Fax:423-559-1483
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN018699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3032152OtherMEDICARE - INDIVIDUAL
TNA99578OtherMEDICARE UPIN
TN0078692OtherBCBS TN
GA320350OtherBCBS GA
TN3719860OtherMEDICARE - GROUP
TN3032152OtherMEDICAID
TNA99578OtherHEALTHSPRING
TN3032152Medicaid
TN1584771OtherGHI
TNTN0101OtherUHC RIVER VALLEY / JDHC
TNA99578OtherMEDICARE UPIN
TN3719860OtherMEDICARE - GROUP