Provider Demographics
NPI:1881789063
Name:SWAIN, BERNICE RENEE (DO)
Entity type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:RENEE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2506 DANVILLE RD SW STE 203
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4232
Mailing Address - Country:US
Mailing Address - Phone:256-341-0043
Mailing Address - Fax:256-341-0095
Practice Address - Street 1:2424 DANVILLE RD SW
Practice Address - Street 2:STE L
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4219
Practice Address - Country:US
Practice Address - Phone:256-341-0043
Practice Address - Fax:256-341-0095
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO 248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000084021Medicaid
ALE-82814Medicare UPIN
AL000084021Medicare ID - Type Unspecified
AL000084021Medicare PIN