Healthcare Provider Details

I. General information

NPI: 1477841393
Provider Name (Legal Business Name): KAREN BUHARIWALLA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 SIXES RD STE 220
HOLLY SPRINGS GA
30115-8722
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1611
US

V. Phone/Fax

Practice location:
  • Phone: 770-721-9660
  • Fax: 770-721-9661
Mailing address:
  • Phone: 404-303-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5315049901
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number075608
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: