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NPI Code Detail

MEDICARE: DR. STANLEY SETH BUSH III M.D.

MEDICARE: DR. STANLEY SETH BUSH III M.D.
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
1208000000XPediatrics Physician048846GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1582566360OTHERGACIGNA HEALTHCARE
2582566360OTHERGAUNITED HEALTHCARE
3582566360OTHERGAAETNA
4582566360OTHERGAMAILHANDLERS
5582566360OTHERGASTATE HEALTH BENEFIT PLAN
6582566360OTHERGASECURE HEALTH PLANS
7582566360OTHERGACORE ADMINISTRATIVE SVCS
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9582566360OTHERGABCBS

General Provider Information

NPI Number : 1578500591
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STANLEY SETH BUSH III M.D.
Provider Business Mailing Address
First Line : 1508B HARDEMAN AVE
Second Line :
City : MACON
State : GA
Zip : 31201-1416
Country : US
Telephone Number : 478-741-7337
Fax Number : 478-741-7371
Provider Business Practice Location Address
First Line : 1508B HARDEMAN AVE
Second Line :
City : MACON
State : GA
Zip : 31201-1416
Country : US
Telephone Number : 478-741-7337
Fax Number : 478-741-7371
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 09/23/2014

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