Provider Demographics
NPI:1154436681
Name:BUAFO, CHARLES K (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:BUAFO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:770 PINE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2173
Mailing Address - Country:US
Mailing Address - Phone:478-741-4455
Mailing Address - Fax:478-742-8041
Practice Address - Street 1:770 PINE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2173
Practice Address - Country:US
Practice Address - Phone:478-741-4455
Practice Address - Fax:478-742-8041
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00244582AMedicaid
GAD29034Medicare UPIN