Provider Demographics
NPI:1316586027
Name:BUFORD, RAHIEM
Entity Type:Individual
Prefix:
First Name:RAHIEM
Middle Name:
Last Name:BUFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 RALPH DAVID ABERNATHY BLVD SW APT D201
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-1271
Mailing Address - Country:US
Mailing Address - Phone:404-484-2706
Mailing Address - Fax:
Practice Address - Street 1:1537 RALPH DAVID ABERNATHY BLVD SW APT D201
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-1271
Practice Address - Country:US
Practice Address - Phone:404-484-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver