Basic Information
Provider Information | |||||||||
NPI: | 1003105727 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SWORDS | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | A. | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | VIEBROCK | ||||||||
OtherFirstName: | CHRISTINE | ||||||||
OtherMiddleName: | A. | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 15849 | ||||||||
Address2: |   | ||||||||
City: | SAVANNAH | ||||||||
State: | GA | ||||||||
PostalCode: | 314162549 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9123033552 | ||||||||
FaxNumber: | 9123033506 | ||||||||
Practice Location | |||||||||
Address1: | 455 S MAIN ST | ||||||||
Address2: | SUITE 201 | ||||||||
City: | HINESVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 313134353 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9128776822 | ||||||||
FaxNumber: | 9124086781 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/04/2011 | ||||||||
LastUpdateDate: | 04/04/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN184840 | GA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | RN184840 | 01 | GA | GA MEDICAL LICENSE | OTHER |