Provider Demographics
NPI:1568463206
Name:SWOFFORD, WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:SWOFFORD
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 1:112 N CUTHBERT ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-3419
Mailing Address - Country:US
Mailing Address - Phone:229-758-3002
Mailing Address - Fax:229-758-9415
Practice Address - Street 1:103 W PINE ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-3526
Practice Address - Country:US
Practice Address - Phone:229-758-3002
Practice Address - Fax:229-758-9415
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00815515CMedicaid
GA00815515CMedicaid
GA08BBTMHMedicare ID - Type Unspecified