Provider Demographics
NPI:1871525428
Name:BUCHANAN, BRENDA D (CRNA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:D
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 WELLBROOK CIRCLE
Mailing Address - Street 2:A
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3872
Mailing Address - Country:US
Mailing Address - Phone:770-929-9033
Mailing Address - Fax:770-929-9092
Practice Address - Street 1:1388 WELLBROOK CIRCLE
Practice Address - Street 2:A
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3872
Practice Address - Country:US
Practice Address - Phone:770-929-9033
Practice Address - Fax:770-929-9092
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN034285367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA430068276OtherRAILROAD MEDICARE PROV #
GA00782394BMedicaid
GA430068276OtherRAILROAD MEDICARE PROV #
GAS41057Medicare UPIN