Healthcare Provider Details

I. General information

NPI: 1942104161
Provider Name (Legal Business Name): CHRISTEL M BUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 CANDLER RD
DECATUR GA
30032-5508
US

IV. Provider business mailing address

8100 TUPELO TRL
JONESBORO GA
30236-3958
US

V. Phone/Fax

Practice location:
  • Phone: 404-284-9912
  • Fax:
Mailing address:
  • Phone: 404-284-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036494
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: