Provider Demographics
NPI:1912374992
Name:BUCK, COURTNEY L (RD,LDN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:BUCK
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1802 ABBEY CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1802 ABBEY CT
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6017
Practice Address - Country:US
Practice Address - Phone:678-554-7576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDN0000003764133V00000X
NCL005326133V00000X
GALD004300133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered