Healthcare Provider Details

I. General information

NPI: 1699510206
Provider Name (Legal Business Name): THOMES BUCHANAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SNOW ST STE C
OXFORD AL
36203-5402
US

IV. Provider business mailing address

320 SNOW ST STE C
OXFORD AL
36203-5402
US

V. Phone/Fax

Practice location:
  • Phone: 256-343-4080
  • Fax:
Mailing address:
  • Phone: 256-343-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberALC04925
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: