MEDICARE: HANNAH IVEY BUSH MT-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225A00000X	Music Therapist	10528	GA

General Provider Information

NPI Number	:	1063850022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH IVEY BUSH MT-BC

Provider Business Mailing Address
First Line	:	5149 ROSWELL RD UNIT 1
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-2234
Country	:	US
Telephone Number	:	706-499-0653
Fax Number	:

Provider Business Practice Location Address
First Line	:	4280 HICKORY FLAT HWY STE 108
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-6634
Country	:	US
Telephone Number	:	770-345-2804
Fax Number	:	770-783-5049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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