Healthcare Provider Details

I. General information

NPI: 1073743175
Provider Name (Legal Business Name): BUCKEYE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2009
Last Update Date: 07/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3286 BUCKEYE RD STE 102
ATLANTA GA
30341-4228
US

IV. Provider business mailing address

3286 BUCKEYE RD STE 102
ATLANTA GA
30341-4228
US

V. Phone/Fax

Practice location:
  • Phone: 770-455-4600
  • Fax:
Mailing address:
  • Phone: 770-455-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0688103
License Number StateGA

VIII. Authorized Official

Name: MRS. SARA BADIE
Title or Position: BILLING MANAGER
Credential:
Phone: 770-455-4600