Provider Demographics
NPI:1578919569
Name:THE SWINFORD CLINIC, LLC
Entity Type:Organization
Organization Name:THE SWINFORD CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SWINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:404-985-1835
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:404-985-1835
Mailing Address - Fax:
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:404-985-1835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011091251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare