Provider Demographics
NPI:1750049011
Name:SWAFFORD, SHANNAN M (DHA)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:M
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 EDGEWATER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-4230
Mailing Address - Country:US
Mailing Address - Phone:423-667-6843
Mailing Address - Fax:
Practice Address - Street 1:1349 MARKET ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1267
Practice Address - Country:US
Practice Address - Phone:423-667-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker