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General NPI Number Information
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NPI Number | 1073584504
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Entity Type | Individual
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Provider Name | MICHAEL SHANE BUSMAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 922 E JEFFERSON ST SUITE B
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City | AMERICUS
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State | GA
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Zip | 31709-4780
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Country | US
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Telephone | 229-924-2383
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Fax | 229-924-0684
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Provider Business Mailing Address
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Address Line | PO BOX 6815
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City | AMERICUS
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State | GA
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Zip | 31709-6815
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Country | US
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Telephone | 229-924-2383
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Fax | 229-924-0684
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 040628
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License Number State | GA
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