Provider Demographics
NPI:1053359851
Name:SWINTON JAMISON, AYANNA (MD)
Entity type:Individual
Prefix:MRS
First Name:AYANNA
Middle Name:
Last Name:SWINTON JAMISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 READ ST STE I-10
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-7861
Mailing Address - Country:US
Mailing Address - Phone:803-256-0101
Mailing Address - Fax:800-854-3497
Practice Address - Street 1:2601 READ ST STE I-10
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-7861
Practice Address - Country:US
Practice Address - Phone:803-256-0101
Practice Address - Fax:800-854-3497
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC229432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC229434Medicaid
SCAA11950281Medicare PIN