Provider Demographics
NPI:1487945945
Name:BUICE, JONATHAN AARON (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:AARON
Last Name:BUICE
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:PO BOX 422002
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-9002
Mailing Address - Country:US
Mailing Address - Phone:770-894-7002
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-381-6806
Practice Address - Fax:704-381-6841
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA786152080P0204X, 208000000X
ALMD.33337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-49844OtherBCBS
AL160753Medicaid
AL160757Medicaid
AL511-49842OtherBCBS