Healthcare Provider Details

I. General information

NPI: 1205199197
Provider Name (Legal Business Name): STEPHANIE BUSBY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2012
Last Update Date: 03/28/2021
Certification Date: 03/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF TENNESSEE 910 MADISON AVENUE SUITE 1031
MEMPHIS TN
38163-0001
US

IV. Provider business mailing address

EMORY SCHOOL OF MEDICINE 69 JESSE HILL DRIVE SE
ATLANTA GA
30303-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-7635
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number078401
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: