Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 637 | AL |
Y | 103TC0700X | Clinical Psychologist | 637 | AL |
NPI | 1013127182 |
---|---|
Provider Name | Dr. Gregory Morris Swanner |
First Address | Athens, AL 35611-5805 |
Second Address | Athens, AL 35611-5805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73683 | BLUE CROSS BLUE SHIELD (01) | AL |
R36168 | (02) | AL |