Healthcare Provider Details

I. General information

NPI: 1568500676
Provider Name (Legal Business Name): BUFFY HOWARD RT (R) (CT)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BUFFY BELCHER

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

4709 WOODLAND DR
OOLTEWAH TN
37363-8434
US

V. Phone/Fax

Practice location:
  • Phone: 803-776-4000
  • Fax:
Mailing address:
  • Phone: 423-320-6958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number345125
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: