Healthcare Provider Details

I. General information

NPI: 1184715377
Provider Name (Legal Business Name): DONALD T BUCKNER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 BONNIE LN
SYLVA NC
28779-8511
US

IV. Provider business mailing address

220 5TH AVE E
HENDERSONVILLE NC
28792-4377
US

V. Phone/Fax

Practice location:
  • Phone: 828-631-3973
  • Fax:
Mailing address:
  • Phone: 828-692-4289
  • Fax: 828-696-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number36153
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36153
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: