MEDICARE: MICHAYALA 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
1	363LF0000X	Family Nurse Practitioner	NCO-000001	GA

General Provider Information

NPI Number	:	1396288684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAYALA BUSH

Provider Business Mailing Address
First Line	:	164 PAUL ST
Second Line	:	PO BOX 267
City	:	SMITHVILLE
State	:	GA
Zip	:	31787-2653
Country	:	US
Telephone Number	:	229-938-9764
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 PAUL ST
Second Line	:
City	:	SMITHVILLE
State	:	GA
Zip	:	31787-2653
Country	:	US
Telephone Number	:	229-938-9764
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	11/18/2016

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Directions to “ MICHAYALA BUSH ” Practice Location

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