Healthcare Provider Details

I. General information

NPI: 1861538944
Provider Name (Legal Business Name): JEFF L BUSH, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2322 WRIGHTSBORO RD
AUGUSTA GA
30904-6233
US

IV. Provider business mailing address

PO BOX 3545
AUGUSTA GA
30914-3545
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-6495
  • Fax: 706-364-6496
Mailing address:
  • Phone: 706-364-6495
  • Fax: 706-364-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number051300
License Number StateGA

VIII. Authorized Official

Name: DR. JEFF L BUSH
Title or Position: OWNER
Credential: M.D.
Phone: 706-364-6495