Individual
DR. JILL BUCKTHAL-MCCUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 COWLES CLINC WAY, ASPEN COTTAGES, GREENSBORO, GA 30642-5285
(706) 225-7177
Mailing address
710 NEWNAN CROSSING BYP, NEWNAN, GA 30263-2384
(770) 251-5111
(770) 254-8680
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
061214
GA
207NS0135X
Procedural Dermatology Physician
61214
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
874913241A
—
GA
01
—
P00693238
RAILROAD MEDICARE
GA
Enumeration date
04/25/2007
Last updated
06/09/2010
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