Provider Demographics
NPI:1972574242
Name:SWANN, LISA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:SWANN
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:151 PEACHWOOD CENTRE DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2575
Practice Address - Country:US
Practice Address - Phone:864-560-9927
Practice Address - Fax:864-562-5470
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11913208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC119133Medicaid
SCH470968510OtherMEDICARE PIN
SCSCF034J577OtherMEDICARE PIN
SCSCF0346084OtherMEDICARE PIN
SCSCF0346067OtherMEDICARE PIN
SCSCF0346121OtherMEDICARE PIN
SCH470969068OtherMEDICARE PIN