Provider Demographics
NPI:1811547623
Name:SWAYZE, MADISON RAE (MED)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:RAE
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:RAE
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:932 CARRAWAY LN
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-0710
Mailing Address - Country:US
Mailing Address - Phone:615-200-0539
Mailing Address - Fax:
Practice Address - Street 1:5205 MARYLAND WAY
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1006
Practice Address - Country:US
Practice Address - Phone:615-200-0539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health