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General NPI Number Information
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NPI Number | 1801355607
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Entity Type | Individual
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Provider Name | ANDREW MADISON BUCKELEW DO
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Gender | Male
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Dates
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Enumeration Date | 03/19/2019
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1001 JOHNSON FERRY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1605
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Country | US
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Telephone | 678-344-1960
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Fax | 404-785-9168
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Provider Business Mailing Address
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Address Line | 1001 JOHNSON FY RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-1605
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Country | US
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Telephone | 678-344-1960
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Fax | 404-907-4257
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 99101
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS18983
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 30451
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 99101
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License Number State | GA
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