Healthcare Provider Details

I. General information

NPI: 1235725383
Provider Name (Legal Business Name): HOWARD KELLY BUFFINGTON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 REDMOND RD NW
ROME GA
30165-1416
US

IV. Provider business mailing address

504 REDMOND RD NW
ROME GA
30165-1416
US

V. Phone/Fax

Practice location:
  • Phone: 706-528-9060
  • Fax: 706-290-2399
Mailing address:
  • Phone: 706-528-9060
  • Fax: 706-290-2399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09201666
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: