Provider Demographics
NPI:1982679684
Name:BUCHANAN, JOHN MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:3575 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1155
Practice Address - Country:US
Practice Address - Phone:770-848-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054557207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08CBBNCOtherMEDICARE PIN THE BRASELTON CLINIC
GA444911088NMedicaid
GA444911088SMedicaid
GA08CBCHPOtherMEDICARE PIN QUICK CARE
GA444911088PMedicaid
GA444911088LMedicaid
GA444911088QMedicaid
GA511I080027OtherMEDICARE PIN ADVANTAGE SPORTS MEDICINE
GAH12363Medicare UPIN