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NPI Code Detail

MEDICARE: COURTNEY L BUCK RD,LDN

MEDICARE:   COURTNEY L BUCK  RD,LDN
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
1133V00000XRegistered DietitianLDN0000003764TN
2133V00000XRegistered DietitianL005326NC
3133V00000XRegistered DietitianLD004300GA

General Provider Information

NPI Number : 1912374992
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY L BUCK RD,LDN
Provider Business Mailing Address
First Line : 1802 ABBEY CT
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-6017
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1802 ABBEY CT
Second Line :
City : ALPHARETTA
State : GA
Zip : 30004-6017
Country : US
Telephone Number : 678-554-7576
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2015
Last Update Date : 02/25/2023

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Directions to “ COURTNEY L BUCK RD,LDN” Practice Location

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