Healthcare Provider Details

I. General information

NPI: 1508340456
Provider Name (Legal Business Name): FARAH ABDI BUCK APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2386 BOLTON RD NW
ATLANTA GA
30318-1232
US

IV. Provider business mailing address

885 WOODSTOCK RD STE 430
ROSWELL GA
30075-2211
US

V. Phone/Fax

Practice location:
  • Phone: 404-352-2810
  • Fax: 404-605-0602
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN330783
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN330783
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberRN330783
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: