Provider Demographics
NPI:1568415164
Name:SWAUNCY, MOSES ANDRE
Entity Type:Individual
Prefix:
First Name:MOSES
Middle Name:ANDRE
Last Name:SWAUNCY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 JACKSON SQUARE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA VERGNE
Mailing Address - State:TN
Mailing Address - Zip Code:37086-2767
Mailing Address - Country:US
Mailing Address - Phone:615-793-9900
Mailing Address - Fax:615-793-9990
Practice Address - Street 1:6001 JACKSON SQUARE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LA VERGNE
Practice Address - State:TN
Practice Address - Zip Code:37086-2767
Practice Address - Country:US
Practice Address - Phone:615-793-9900
Practice Address - Fax:615-793-9990
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine