Healthcare Provider Details

I. General information

NPI: 1477102713
Provider Name (Legal Business Name): TAMMY A BUCHANON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 ROBERT B LEE DR
LEESBURG GA
31763-2600
US

IV. Provider business mailing address

2415 EFFLER RD
MARYVILLE TN
37803-6609
US

V. Phone/Fax

Practice location:
  • Phone: 229-759-6508
  • Fax:
Mailing address:
  • Phone: 865-850-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number305569
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: