Healthcare Provider Details

I. General information

NPI: 1477872810
Provider Name (Legal Business Name): CAROLINE BLACK BUCHANAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 EDGEWOOD DR
GREENVILLE SC
29605-4246
US

IV. Provider business mailing address

101 GREGOR MENDEL CIR
GREENWOOD SC
29646-2316
US

V. Phone/Fax

Practice location:
  • Phone: 864-250-7944
  • Fax: 864-250-9582
Mailing address:
  • Phone: 864-388-1072
  • Fax: 864-388-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number32645
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: