Provider Demographics
NPI:1205862547
Name:BUCKLEY, GEORGIA JAMILLAH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:JAMILLAH
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 2376
Mailing Address - Street 2:
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-2376
Mailing Address - Country:US
Mailing Address - Phone:910-302-3801
Mailing Address - Fax:828-538-4441
Practice Address - Street 1:1536 OWEN PARK LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3454
Practice Address - Country:US
Practice Address - Phone:910-307-1576
Practice Address - Fax:910-500-3117
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-00442363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant