Healthcare Provider Details

I. General information

NPI: 1306432703
Provider Name (Legal Business Name): JOSEPH BUSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2020
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 TOWER RD NE STE 300
MARIETTA GA
30060-9408
US

IV. Provider business mailing address

355 TOWER RD NE STE 300
MARIETTA GA
30060-9408
US

V. Phone/Fax

Practice location:
  • Phone: 770-427-2457
  • Fax: 770-427-2706
Mailing address:
  • Phone: 770-427-2457
  • Fax: 770-427-2706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number99462
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: