Healthcare Provider Details

I. General information

NPI: 1306242508
Provider Name (Legal Business Name): SONJA BUSH CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2014
Last Update Date: 11/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 PANTHERSVILLE RD
DECATUR GA
30034-3828
US

IV. Provider business mailing address

3073 PANTHERSVILLE RD
DECATUR GA
30034-3828
US

V. Phone/Fax

Practice location:
  • Phone: 404-212-4780
  • Fax:
Mailing address:
  • Phone: 404-212-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number5525
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: