Provider Demographics
NPI:1295801215
Name:BUCHANAN, CONNIE N (MS, NP-C, FNP)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:N
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MS, NP-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 LANIER BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3511
Mailing Address - Country:US
Mailing Address - Phone:404-876-4502
Mailing Address - Fax:
Practice Address - Street 1:173 BOULEVARD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1313
Practice Address - Country:US
Practice Address - Phone:404-658-1500
Practice Address - Fax:404-658-1535
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN043637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner