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General NPI Number Information
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NPI Number | 1801682240
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Entity Type | Individual
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Provider Name | JONATHAN BUCHANAN FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 1301 48TH AVE N STE B
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City | MYRTLE BEACH
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State | SC
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Zip | 29577-5427
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Country | US
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Telephone | 843-497-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 102 SPANISH OAK DR
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City | MYRTLE BEACH
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State | SC
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Zip | 29575-4728
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Country | US
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Telephone | 843-344-3448
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29858
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | 29858
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License Number State | SC
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