Provider Demographics
NPI:1518859883
Name:SWANSON, ALEXANDRIA (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:SWANSON
Suffix:
Gender:X
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 THE 5TH GRN
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1624
Mailing Address - Country:US
Mailing Address - Phone:770-355-4117
Mailing Address - Fax:
Practice Address - Street 1:8655 THE 5TH GRN
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-1624
Practice Address - Country:US
Practice Address - Phone:770-355-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13176363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical