Healthcare Provider Details

I. General information

NPI: 1770457103
Provider Name (Legal Business Name): CALVIN ALEXANDER BUFORD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5680 FULTON INDUSTRIAL BLVD SW
ATLANTA GA
30336-2659
US

IV. Provider business mailing address

3060 DELMAR LN NW UNIT 4
ATLANTA GA
30311-1135
US

V. Phone/Fax

Practice location:
  • Phone: 404-346-3471
  • Fax:
Mailing address:
  • Phone: 661-236-2564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: