Provider Demographics
NPI:1386855740
Name:BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, P.C
Entity Type:Organization
Organization Name:BUFORD FAMILY PRACTICE AND URGENT CARE CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:OSOWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-541-0588
Mailing Address - Street 1:2805 HAMILTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4110
Mailing Address - Country:US
Mailing Address - Phone:678-541-0588
Mailing Address - Fax:678-541-0610
Practice Address - Street 1:2805 HAMILTON MILL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4110
Practice Address - Country:US
Practice Address - Phone:678-541-0588
Practice Address - Fax:678-541-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057551261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care