Healthcare Provider Details

I. General information

NPI: 1083040372
Provider Name (Legal Business Name): MICHELLE A. BUCKLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 E JACKSON BLVD
SAVANNAH GA
31405-5895
US

IV. Provider business mailing address

706 CENTRAL BLVD
GUYTON GA
31312-4329
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-1010
  • Fax: 912-351-0589
Mailing address:
  • Phone: 912-355-1010
  • Fax: 912-351-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP243991
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: