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NPI Code Detail

MEDICARE: C. SHANE BUSSLER M.D.

MEDICARE: C. SHANE BUSSLER 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
1207R00000XInternal Medicine Physician55813GA

General Provider Information

NPI Number : 1609879881
Entity Type Code : Individual
Provider Name (Legal Business Name) : C. SHANE BUSSLER M.D.
Provider Business Mailing Address
First Line : 1240 JESSE JEWELL PKWY SE
Second Line : SUITE 500
City : GAINESVILLE
State : GA
Zip : 30501-3862
Country : US
Telephone Number : 770-536-9864
Fax Number : 770-297-5010
Provider Business Practice Location Address
First Line : 1240 JESSE JEWELL PKWY SE
Second Line : STE 500
City : GAINESVILLE
State : GA
Zip : 30501-3861
Country : US
Telephone Number : 770-536-9864
Fax Number : 770-297-5010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 04/15/2010

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Directions to “ C. SHANE BUSSLER M.D.” Practice Location

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