Provider Demographics
NPI:1962239319
Name:SWANN, LORI CAMILLE (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:CAMILLE
Last Name:SWANN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W OAKS DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7370
Mailing Address - Country:US
Mailing Address - Phone:678-794-7361
Mailing Address - Fax:
Practice Address - Street 1:1245 NOAH DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-8721
Practice Address - Country:US
Practice Address - Phone:706-253-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN281690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily