Healthcare Provider Details

I. General information

NPI: 1245168988
Provider Name (Legal Business Name): MICHAEL S BUAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 PRINCE AVE
ATHENS GA
30606-6030
US

IV. Provider business mailing address

3141 CHESTERFIELD CT
SNELLVILLE GA
30039-4682
US

V. Phone/Fax

Practice location:
  • Phone: 855-706-3007
  • Fax:
Mailing address:
  • Phone: 404-889-4746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC011008
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: