Active NPI
Jaime Lynn Buckelew, CSFA
- Surgical Assistant
- Marietta, GA
National Provider Identifier
1700366606
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 164724
- Practice address
- 800 Kennesaw Ave NW Ste 120
Marietta, GA 30060-1052 - Phone
- (678) 556-5138
- Fax
- (770) 336-6620
- NPI assigned
- Aug 20, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 164724 | GA | Primary |
Addresses
Primary practice location
800 Kennesaw Ave NW Ste 120
Marietta, GA 30060-1052
Mailing address
800 Kennesaw Ave NW Ste 120
Marietta, GA 30060-1052
Phone (678) 556-5138
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164724 | GA | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1700366606",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 KENNESAW AVE NW STE 120",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601052",
"telephone_number": "678-556-5138",
"fax_number": "770-336-6620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 KENNESAW AVE NW STE 120",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300601052",
"telephone_number": "678-556-5138",
"fax_number": "770-336-6620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUCKELEW",
"first_name": "JAIME",
"middle_name": "LYNN",
"credential": "CSFA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-08-20",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "GA",
"license": "164724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.