Provider Demographics
NPI:1386811149
Name:BUFORD-NORCROSS PRIMARY CARE, P.C.
Entity type:Organization
Organization Name:BUFORD-NORCROSS PRIMARY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:LIQUN
Authorized Official - Last Name:BAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-246-6100
Mailing Address - Street 1:777 W PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1868
Mailing Address - Country:US
Mailing Address - Phone:770-246-6100
Mailing Address - Fax:770-246-6142
Practice Address - Street 1:777 W PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-1868
Practice Address - Country:US
Practice Address - Phone:770-246-6100
Practice Address - Fax:770-246-6142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00753728HMedicaid
GA00753728HMedicaid