Healthcare Provider Details

I. General information

NPI: 1073563037
Provider Name (Legal Business Name): BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 HAMILTON MILL RD STE 1102
BUFORD GA
30519-4006
US

IV. Provider business mailing address

3340 PEACHTREE RD NE BLDG 100, STE 600
ATLANTA GA
30326-1000
US

V. Phone/Fax

Practice location:
  • Phone: 678-541-0588
  • Fax:
Mailing address:
  • Phone: 404-266-9876
  • Fax: 404-266-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number057551
License Number StateGA

VIII. Authorized Official

Name: DR. ALEXANDER E OSOWA
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 678-541-0588