Healthcare Provider Details

I. General information

NPI: 1558781955
Provider Name (Legal Business Name): JOSHUA JERRETT BUSSCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MED TECH PKWY STE 1
JOHNSON CITY TN
37604-4004
US

IV. Provider business mailing address

PO BOX 5820
JOHNSON CITY TN
37602-5820
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-2111
  • Fax: 423-431-0213
Mailing address:
  • Phone: 423-929-2111
  • Fax: 423-431-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number080345
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License Number80345
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: