Provider Demographics
NPI:1801080171
Name:SWINK, REBEKAH LIVINGSTON (MD)
Entity type:Individual
Prefix:DR
First Name:REBEKAH
Middle Name:LIVINGSTON
Last Name:SWINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:ANN
Other - Last Name:LIVINGSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1505 W ELK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-2848
Mailing Address - Country:US
Mailing Address - Phone:423-543-1261
Mailing Address - Fax:423-543-7500
Practice Address - Street 1:1505 W ELK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2848
Practice Address - Country:US
Practice Address - Phone:423-543-1261
Practice Address - Fax:423-543-7500
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6050324OtherBCBS
TN1522343Medicaid
TN103I084788Medicare PIN
TN103I080151Medicare PIN
TNOTH000Medicare UPIN