Individual
DR. SWAROOP NYSHADHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1990 LUKKEN INDUSTRIAL DR W, SUITE C, LAGRANGE, GA 30240-1404
(706) 883-8787
Mailing address
103 CRESTVIEW RD, WEST POINT, GA 31833-5221
(706) 883-8787
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
00013121
AL
208600000X
Surgery Physician
ME 49553
FL
208D00000X
General Practice Physician
Primary
031483
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000338357H
—
GA
Enumeration date
05/25/2006
Last updated
02/21/2013
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