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NPI Code Detail

MEDICARE: AYANNA V BUCKNER MD

MEDICARE: AYANNA V BUCKNER MD
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
12083P0901XPublic Health & General Preventive Medicine Physician056966GA

General Provider Information

NPI Number : 1720059462
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYANNA V BUCKNER MD
Provider Business Mailing Address
First Line : 80 JESSE HILL DR DR SE
Second Line : PO BOX 26042
City : ATLANTA
State : GA
Zip : 30303
Country : US
Telephone Number : 404-616-1000
Fax Number : 404-489-6820
Provider Business Practice Location Address
First Line : 1595 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3200
Country : US
Telephone Number : 404-616-2886
Fax Number : 404-209-1769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 10/22/2018

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