Healthcare Provider Details

I. General information

NPI: 1063093078
Provider Name (Legal Business Name): JOHN THOMAS BUCHANAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 N PATTERSON ST STE 200
VALDOSTA GA
31602-2512
US

IV. Provider business mailing address

2479 HWY 256
SYLVESTER GA
31791-4662
US

V. Phone/Fax

Practice location:
  • Phone: 229-333-1711
  • Fax:
Mailing address:
  • Phone: 229-392-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number111161
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: