Provider Demographics
NPI:1821406190
Name:SWILLEY, GINGER (FNP-C)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:SWILLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-4863
Mailing Address - Country:US
Mailing Address - Phone:770-789-7927
Mailing Address - Fax:
Practice Address - Street 1:715 QUEEN CITY PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4348
Practice Address - Country:US
Practice Address - Phone:770-297-1970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069-140-H207LH0002X
GARN217876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000850055AMedicaid
GA111579Medicare Oscar/Certification