Provider Demographics
NPI:1598866782
Name:BUCHANAN, JASON R (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-3553
Mailing Address - Country:US
Mailing Address - Phone:706-505-4936
Mailing Address - Fax:
Practice Address - Street 1:1838 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-3553
Practice Address - Country:US
Practice Address - Phone:706-505-4936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232674207P00000X, 207Q00000X
GA86671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02648593Medicaid
NY1598866782Medicaid
NY00355266Medicaid
NY02648593Medicaid
NYJ400005707Medicare PIN
NYJ400003796Medicare PIN
I12773Medicare UPIN
NY1598866782Medicaid
NYP00464448Medicare PIN