Basic Information
Provider Information
NPI: 1033181995
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWANSON
FirstName: SVEN
MiddleName: ARLEN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 30309
Address2:  
City: CHARLESTON
State: SC
PostalCode: 294170309
CountryCode: US
TelephoneNumber: 8435549300
FaxNumber: 8435668780
Practice Location
Address1: 1199 PRINCE AVE
Address2:  
City: ATHENS
State: GA
PostalCode: 306062797
CountryCode: US
TelephoneNumber: 7064753398
FaxNumber: 7064756796
Other Information
ProviderEnumerationDate: 02/06/2006
LastUpdateDate: 01/22/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102X044848GAY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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