Healthcare Provider Details

I. General information

NPI: 1265001184
Provider Name (Legal Business Name): JOHN BUCHANAN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD STE 150
DULUTH GA
30096-5144
US

IV. Provider business mailing address

1930 BRANNAN RD
MCDONOUGH GA
30253-4310
US

V. Phone/Fax

Practice location:
  • Phone: 770-979-9427
  • Fax:
Mailing address:
  • Phone: 678-284-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN270043
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN270043
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: