Provider Demographics
NPI:1164708467
Name:BUFFINGTON, JEANNIE MARIE (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:MARIE
Last Name:BUFFINGTON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:MARIE
Other - Last Name:LIGHTSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1073 S INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4717
Mailing Address - Country:US
Mailing Address - Phone:678-209-3440
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:31 ICU
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-291-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN138330363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care