Healthcare Provider Details

I. General information

NPI: 1730683152
Provider Name (Legal Business Name): BENJAMIN ANDREW BUSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number105507
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: