Basic Information
| Provider Information | |||||||||
| NPI: | 1578850343 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWAIN | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 WESLEYAN DR | ||||||||
| Address2: | APT 101 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312108807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623126911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 STILLWATER CIR | ||||||||
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| City: | BONAIRE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310053857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782931680 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 06/30/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT010295 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.