Healthcare Provider Details

I. General information

NPI: 1215857222
Provider Name (Legal Business Name): TERRIAH JESSANAE BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 PINEVIEW DR # 240A
ATHENS GA
30606-8137
US

IV. Provider business mailing address

255 PINEVIEW DR # 240A
ATHENS GA
30606-8137
US

V. Phone/Fax

Practice location:
  • Phone: 706-371-3409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: