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NPI Code Detail

MEDICARE: ETHAN BUSH

MEDICARE: ETHAN BUSH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-24-368560GA

General Provider Information

NPI Number : 1306678420
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN BUSH
Provider Business Mailing Address
First Line : 209 7TH ST FL 3
Second Line :
City : AUGUSTA
State : GA
Zip : 30901-1486
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 209 7TH ST
Second Line :
City : AUGUSTA
State : GA
Zip : 30901-1486
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2024
Last Update Date : 08/16/2024

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Directions to “ ETHAN BUSH ” Practice Location

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