Provider Demographics
NPI:1033998323
Name:SWANSON, JADA (NP)
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:SWANSON
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 1:5462 WHITTLESEY BLVD APT 1017
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3049
Mailing Address - Country:US
Mailing Address - Phone:229-314-5567
Mailing Address - Fax:
Practice Address - Street 1:1201 18TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1724
Practice Address - Country:US
Practice Address - Phone:706-507-3747
Practice Address - Fax:706-507-3638
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily