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General NPI Number Information
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NPI Number | 1902128747
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Entity Type | Individual
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Provider Name | THERESA KASSACK BUCHANAN NP
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Gender | Female
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 134 W CAMPUS DR CBX 091
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061
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Country | US
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Telephone | 478-445-5288
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Fax | 478-445-3142
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Provider Business Mailing Address
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Address Line | 265 LAKE ISLAND DR
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City | SPARTA
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State | GA
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Zip | 31087-5022
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Country | US
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Telephone | 770-412-6880
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN149616
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN149616
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License Number State | GA
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