Provider Demographics
NPI:1891776506
Name:SWAMY, MANJULA S (MD)
Entity Type:Individual
Prefix:
First Name:MANJULA
Middle Name:S
Last Name:SWAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 US HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-5039
Mailing Address - Country:US
Mailing Address - Phone:256-560-2230
Mailing Address - Fax:256-560-2249
Practice Address - Street 1:4218 US HIGHWAY 31 S
Practice Address - Street 2:REGION I
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-5039
Practice Address - Country:US
Practice Address - Phone:256-560-2230
Practice Address - Fax:256-560-2249
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000123282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51528960OtherBCBS
0515529595WAMedicare ID - Type Unspecified
C75908Medicare UPIN