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General NPI Number Information
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NPI Number | 1659402196
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Entity Type | Individual
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Provider Name | CHRISTOPHER M BUCKLEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 2500 HOSPITAL BLVD STE 280
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City | ROSWELL
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State | GA
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Zip | 30076-4918
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Country | US
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Telephone | 770-754-0787
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Fax | 770-755-5890
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Provider Business Mailing Address
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Address Line | 495 BRICKELL AVE APT 2309
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City | MIAMI
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State | FL
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Zip | 33131-2787
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Country | US
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Telephone | 859-576-5774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 075969
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 02910
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | OS9788
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License Number State | FL
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