Provider Demographics
NPI:1013127182
Name:SWANNER, GREGORY MORRIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MORRIS
Last Name:SWANNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19332 HUNTSVILLE BROWNSFERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-5805
Mailing Address - Country:US
Mailing Address - Phone:256-771-1743
Mailing Address - Fax:
Practice Address - Street 1:19332 HUNTSVILLE BROWNSFERRY RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-5805
Practice Address - Country:US
Practice Address - Phone:256-771-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL73683OtherBLUE CROSS BLUE SHIELD
AL73683Medicare ID - Type UnspecifiedPERSONAL
AL74080Medicare ID - Type UnspecifiedNORTH ALABAMA REGIONAL HO
ALR36168Medicare UPIN