MEDICARE: JESSICA BUCKHOLTS

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	247100000X	Radiologic Technologist

General Provider Information

NPI Number	:	1720934367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA BUCKHOLTS

Provider Business Mailing Address
First Line	:	1508 FINCHERVILLE RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-3142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 FINCHERVILLE RD
Second Line	:
City	:	JACKSON
State	:	GA
Zip	:	30233-3142
Country	:	US
Telephone Number	:	770-490-6840
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ JESSICA BUCKHOLTS ” Practice Location

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