Individual
DR. JENNIFER LOUISE BUCKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
835 COGBURN AVE NW, SUITE 100, MARIETTA, GA 30060-1031
(770) 422-5557
(770) 422-5456
Mailing address
835 COGBURN AVE NW, SUITE 100, MARIETTA, GA 30060-1031
(770) 422-5557
(770) 422-5456
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
051441
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00121329
RAILROAD MEDICARE
GA
Enumeration date
02/01/2006
Last updated
06/12/2020
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