Provider Demographics
NPI:1164691846
Name:YORK, BUFFY WOOTEN (NP-C)
Entity Type:Individual
Prefix:
First Name:BUFFY
Middle Name:WOOTEN
Last Name:YORK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:BUFFY
Other - Middle Name:LEE
Other - Last Name:YORK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:275 CLARKS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:GA
Mailing Address - Zip Code:30557-3203
Mailing Address - Country:US
Mailing Address - Phone:706-356-2755
Mailing Address - Fax:
Practice Address - Street 1:1300 TIGER BLVD
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1114
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN128635 NP363LF0000X
SCAPRN 1947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily