Provider Demographics
NPI:1699563536
Name:SWAFFORD, MARY ROSE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ROSE
Last Name:SWAFFORD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 KEEBLE RD
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-4634
Mailing Address - Country:US
Mailing Address - Phone:865-356-9633
Mailing Address - Fax:
Practice Address - Street 1:138 KEEBLE RD
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-4634
Practice Address - Country:US
Practice Address - Phone:865-356-9633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program