Basic Information
| Provider Information | |||||||||
| NPI: | 1073563037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3340 PEACHTREE RD NE | ||||||||
| Address2: | BLDG 100, STE 600 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303261000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042669876 | ||||||||
| FaxNumber: | 4042662669 | ||||||||
| Practice Location | |||||||||
| Address1: | 3331 HAMILTON MILL RD | ||||||||
| Address2: | STE 1102 | ||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305194006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785410588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OSOWA | ||||||||
| AuthorizedOfficialFirstName: | ALEXANDER | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6785410588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 057551 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.