Provider Demographics
NPI:1568430353
Name:SWAIM, MICHAEL GREGG (DPH)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GREGG
Last Name:SWAIM
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3634
Mailing Address - Country:US
Mailing Address - Phone:731-587-9157
Mailing Address - Fax:731-588-5137
Practice Address - Street 1:319 S LINDELL ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2440
Practice Address - Country:US
Practice Address - Phone:731-588-5138
Practice Address - Fax:731-588-5137
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist