Healthcare Provider Details

I. General information

NPI: 1134050842
Provider Name (Legal Business Name): JAELYN BUCHANAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N CREST BLVD
MACON GA
31210-1845
US

IV. Provider business mailing address

150 N CREST BLVD
MACON GA
31210-1845
US

V. Phone/Fax

Practice location:
  • Phone: 478-845-7516
  • Fax:
Mailing address:
  • Phone: 478-845-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: JAELYN BUCHANAN
Title or Position: BEHAVIORAL TECHNICIAN
Credential:
Phone: 678-708-6900