Healthcare Provider Details

I. General information

NPI: 1073775904
Provider Name (Legal Business Name): SUMTER FAMILY MEDICINE & SPORTS MEDICINE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 E JEFFERSON ST SUITE B
AMERICUS GA
31709-4780
US

IV. Provider business mailing address

PO BOX 6815
AMERICUS GA
31709-6815
US

V. Phone/Fax

Practice location:
  • Phone: 229-924-2383
  • Fax: 229-924-0684
Mailing address:
  • Phone: 229-924-2383
  • Fax: 229-924-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number040628
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL SHANE BUSMAN
Title or Position: M.D.
Credential: M.D.
Phone: 229-924-2383