Healthcare Provider Details

I. General information

NPI: 1336149210
Provider Name (Legal Business Name): IRIS BUCHANAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 WESTVIEW DRIVE, SW HARRIS BUILDING, SUITE 100-A
ATLANTA GA
30310-1458
US

IV. Provider business mailing address

720 WESTVIEW DR SW HARRIS BUILDING, SUITE 100-A
ATLANTA GA
30310-1458
US

V. Phone/Fax

Practice location:
  • Phone: 404-756-1400
  • Fax: 404-756-5274
Mailing address:
  • Phone: 404-756-1400
  • Fax: 404-756-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number026834
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number026834
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: