Provider Demographics
NPI:1073563037
Name:BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, PC
Entity Type:Organization
Organization Name:BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:E
Authorized Official - Last Name:OSOWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-541-0588
Mailing Address - Street 1:3340 PEACHTREE RD NE
Mailing Address - Street 2:BLDG 100, STE 600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1000
Mailing Address - Country:US
Mailing Address - Phone:404-266-9876
Mailing Address - Fax:404-266-2669
Practice Address - Street 1:3331 HAMILTON MILL RD
Practice Address - Street 2:STE 1102
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4006
Practice Address - Country:US
Practice Address - Phone:678-541-0588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057551207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty