Provider Demographics
NPI:1902665912
Name:SWAMINATHAN, NAGARAJ
Entity Type:Individual
Prefix:
First Name:NAGARAJ
Middle Name:
Last Name:SWAMINATHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 RA DENT GB 3341
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-1538
Mailing Address - Country:US
Mailing Address - Phone:706-721-3417
Mailing Address - Fax:
Practice Address - Street 1:1301 RA DENT GB 3341
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-1538
Practice Address - Country:US
Practice Address - Phone:706-721-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health