Provider Demographics
NPI:1083729446
Name:BUFFINGTON, SHONTAE R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHONTAE
Middle Name:R
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3779
Mailing Address - Country:US
Mailing Address - Phone:912-466-5870
Mailing Address - Fax:912-466-5883
Practice Address - Street 1:3300 4TH ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3779
Practice Address - Country:US
Practice Address - Phone:912-466-5870
Practice Address - Fax:912-466-5883
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71051208000000X
TN46947208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics