Healthcare Provider Details

I. General information

NPI: 1518802511
Provider Name (Legal Business Name): ROBERTA BUSSEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7204 CURACAS DR
AUGUSTA GA
30909-4788
US

IV. Provider business mailing address

7204 CURACAS DR
AUGUSTA GA
30909-4788
US

V. Phone/Fax

Practice location:
  • Phone: 706-495-9276
  • Fax:
Mailing address:
  • Phone: 706-495-9276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN715025
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: