Provider Demographics
NPI:1568231769
Name:BUFFKIN, MICHELLE (LMT, CPT, LE)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BUFFKIN
Suffix:
Gender:F
Credentials:LMT, CPT, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6065 ROSWELL RD STE 405
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4014
Mailing Address - Country:US
Mailing Address - Phone:770-856-0675
Mailing Address - Fax:
Practice Address - Street 1:6065 ROSWELL RD STE 405
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4014
Practice Address - Country:US
Practice Address - Phone:770-856-0675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty