Healthcare Provider Details

I. General information

NPI: 1518733906
Provider Name (Legal Business Name): KATHARINE ALYSSA BUECHNER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MARTIN LUTHER KING JR DR SW
ATLANTA GA
30331-3674
US

IV. Provider business mailing address

976 BOULDERCREST DR SE
ATLANTA GA
30316-2261
US

V. Phone/Fax

Practice location:
  • Phone: 470-825-1341
  • Fax:
Mailing address:
  • Phone: 678-592-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMSW011417
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: