Provider Demographics
NPI:1548485857
Name:SWAFFORD, TEABRA (MD)
Entity type:Individual
Prefix:
First Name:TEABRA
Middle Name:
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TEABRA
Other - Middle Name:
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:975 E. THIRD STREET
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-778-5630
Mailing Address - Fax:423-778-3146
Practice Address - Street 1:975 E. THIRD STREET
Practice Address - Street 2:BOX #290- ATTN: UNIVERSITY HOSPITALISTS
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2147
Practice Address - Country:US
Practice Address - Phone:423-266-1490
Practice Address - Fax:423-778-2108
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44250207R00000X
VA0101242297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA015958C21Medicare PIN
VA015958C19Medicare PIN
VA1548485857Medicaid