Provider Demographics
NPI:1013143528
Name:SWAFFORD, CHRISTINE NICOLE (MS, RD, LD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 RALPH MCGILL BLVD NE APT 2310
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4366
Mailing Address - Country:US
Mailing Address - Phone:706-338-2282
Mailing Address - Fax:404-761-2618
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:SUITE 516
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7129
Practice Address - Country:US
Practice Address - Phone:404-761-0819
Practice Address - Fax:404-768-2336
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD003192133V00000X, 133VN1005X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic