MEDICARE: MRS. GEORGIA JAMILLAH BUCKLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-00442	NC

General Provider Information

NPI Number	:	1205862547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GEORGIA JAMILLAH BUCKLEY PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2376
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-2376
Country	:	US
Telephone Number	:	910-302-3801
Fax Number	:	828-538-4441

Provider Business Practice Location Address
First Line	:	1536 OWEN PARK LN
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-3454
Country	:	US
Telephone Number	:	910-307-1576
Fax Number	:	910-500-3117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/10/2023

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