Individual
BRIAN GORDON BUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 812-5730
(770) 838-8563
Mailing address
PO BOX 73709, NEWNAN, GA 30271-3709
(770) 251-2060
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN099295
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000578586C
—
GA
05
—
491431789A
—
GA
Enumeration date
11/17/2005
Last updated
11/22/2019
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