Provider Demographics
NPI:1477094464
Name:SWINFORD, AMBER MARIE (LMT)
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:MARIE
Last Name:SWINFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 S ERWIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3560
Mailing Address - Country:US
Mailing Address - Phone:470-315-4826
Mailing Address - Fax:855-710-7430
Practice Address - Street 1:12 S ERWIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3560
Practice Address - Country:US
Practice Address - Phone:470-315-4826
Practice Address - Fax:855-710-7430
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011091251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare