Provider Demographics
NPI:1447954904
Name:SWIFT, DIAMOND MADISON
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:MADISON
Last Name:SWIFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GOVERNORS TRCE STE 101
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4853
Mailing Address - Country:US
Mailing Address - Phone:470-682-3536
Mailing Address - Fax:470-682-3646
Practice Address - Street 1:100 GOVERNORS TRCE STE 101
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4853
Practice Address - Country:US
Practice Address - Phone:470-682-3536
Practice Address - Fax:470-682-3646
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician