Organization
SWIFT FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANGELA COPELAND (CREDENTIALING COORDINATOR)
(770) 778-2994
Entity
Organization
Contact information
Practice address
5185 OLD NATIONAL HWY, COLLEGE PARK, GA 30349-3244
(404) 763-9300
Mailing address
5185 OLD NATIONAL HWY, COLLEGE PARK, GA 30349-3244
(404) 763-9300
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
63084
GA
207Q00000X
Family Medicine Physician
Primary
63084
GA
207R00000X
Internal Medicine Physician
63084
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962667915
NPI
GA
Enumeration date
04/07/2016
Last updated
04/07/2016
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