Individual provider Active NPI

Gwynn D Swallows, PA-C

  • Emergency Medicine Physician
  • Chattanooga, TN
National Provider Identifier
1649208299
Registry record updated Nov 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
PA0407 Issued in TN
Practice address
2525 Desales Avenue
Chattanooga, TN 37404
Phone
(423) 697-0014
Fax
(423) 648-6280
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X PA00407 TN
Emergency Medicine Physician 207P00000X PA0407 TN Primary

Addresses

Primary practice location

2525 Desales Avenue
Chattanooga, TN 37404

Mailing address

725 Glenwood Drive,
Suite E-487
Chattanooga, TN 37404
Phone (423) 697-0014

Other identifiers 1

IdentifierTypeStateIssuer
189041088BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA, AK3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20071205000524 TN Practitioner - Physician Assistant 9638268188 Reassigns benefits to 1 organization
I20210323001626 GA Practitioner - Physician Assistant 9638268188 Reassigns benefits to 1 organization
I20250108000719 AK Practitioner - Physician Assistant 9638268188 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2799GAMDClinical Psychologist
PA0407TNMDEmergency Medicine Physician
PA00407TNMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Chattanooga Emergency Medicine PLLC CurrentSince Jul 1, 2007 Accepting new patients
Norton Sound Health Corporation CurrentSince Dec 9, 2024 Accepting new patients
Norton Sound Health Corporation CurrentSince Dec 9, 2024 Accepting new patients
University Health System Inc Past Accepting new patients
Emergency Medical Associates Past Accepting new patients
Emergency Medical Associates Past Accepting new patients
Southeastern Emergency Services P C Past Accepting new patients

Locations

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

725 Glenwood Dr
Ste E487
Chattanooga, TN 37404
Phone (423) 697-0014

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321574400000",
    "number": "1649208299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 GLENWOOD DRIVE,",
            "address_2": "SUITE E-487",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37404",
            "telephone_number": "423-697-0014",
            "fax_number": "423-648-6280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 DESALES AVENUE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "37404",
            "telephone_number": "423-697-0014",
            "fax_number": "423-648-6280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWALLOWS",
        "first_name": "GWYNN",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2011-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "PA00407",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TN",
            "license": "PA0407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "189041088B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.