Healthcare Provider Details

I. General information

NPI: 1629631908
Provider Name (Legal Business Name): CARL JON BUCHHOLZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 S SOUTH ST
MOUNT AIRY NC
27030-5330
US

IV. Provider business mailing address

PO BOX 1267
MOUNT AIRY NC
27030-1267
US

V. Phone/Fax

Practice location:
  • Phone: 336-783-8900
  • Fax: 336-786-3778
Mailing address:
  • Phone: 480-322-5787
  • Fax: 336-786-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2024-01440
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: