Provider Demographics
NPI:1104058213
Name:SWAIN, FREDDIE R (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:R
Last Name:SWAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN567072085R0202X
GA576862085R0202X
WAMD604793842085R0202X
ALMD.363762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL206371Medicaid
AL206380Medicaid
AL207599Medicaid
AL210440Medicaid
AL248000Medicaid
AL238645Medicaid
AL512.-36317OtherBCBS
13587482OtherCAQH
AL207600Medicaid
AL207768Medicaid
AL208805Medicaid
AL210146Medicaid
AL1588621296Medicaid
AL211029Medicaid
AL512-04929OtherBCBS
AL247994Medicaid
AL248628Medicaid
AL512-36316OtherBCBS
AL266342Medicaid
AL512-36517OtherBCBS
AL890-51395OtherBCBS
AL207781Medicaid
AL247990Medicaid
AL512-30595OtherBCBS
AL512-36515OtherBCBS