NPIMap

Individual provider Active NPI

Georgia Jamillah Buckley, PA-C

  • Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1205862547
Registry record updated Aug 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-00442 Issued in NC
Practice address
1536 Owen Park LN
Fayetteville, NC 28304-3454
Phone
(910) 307-1576
Fax
(910) 500-3117
NPI assigned
Jun 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-00442 NC Primary

Addresses

Primary practice location

1536 Owen Park LN
Fayetteville, NC 28304-3454

Mailing address

PO Box 2376
Bryson City, NC 28713-2376
Phone (910) 302-3801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061102000264 NC Practitioner - Physician Assistant 0840297909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1536 Owen Park LN
Fayetteville, NC 28304-3454
Phone (910) 302-3801

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-00442NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Womens Health Haven Obstetrics and Gynecology CurrentSince May 1, 2022 Accepting new patients
FHPG, LLC PastSince Aug 13, 2023 Accepting new patients
Bladen Medical Associates Past Accepting new patients

Locations

2573 Ravenhill Dr
Fayetteville, NC 28303
Phone (910) 307-1576

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGEICD/Endpoint/DGEICD

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691625600000",
    "number": "1205862547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2376",
            "city": "BRYSON CITY",
            "state": "NC",
            "postal_code": "287132376",
            "telephone_number": "910-302-3801",
            "fax_number": "828-538-4441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 OWEN PARK LN",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043454",
            "telephone_number": "910-307-1576",
            "fax_number": "910-500-3117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "GEORGIA",
        "middle_name": "JAMILLAH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-00442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.