Provider Demographics
NPI:1841008935
Name:BUCHANAN, TOMMY
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 PHILLIPS AVE BLDG E
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1351
Mailing Address - Country:US
Mailing Address - Phone:419-378-9212
Mailing Address - Fax:
Practice Address - Street 1:400 E STATE ST STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1870
Practice Address - Country:US
Practice Address - Phone:740-326-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health