MEDICARE: ANNIE MARLENE RILEY-BUSSEY MD

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	207Q00000X	Family Medicine Physician	4301070450	MI
2	207Q00000X	Family Medicine Physician	2009-01358	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	700H248710	OTHER	MI	BLUE CROSS GROUP NUMBER
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609885698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE MARLENE RILEY-BUSSEY MD

Provider Business Mailing Address
First Line	:	4372 FERNCREEK DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-2525
Country	:	US
Telephone Number	:	910-570-3113
Fax Number	:	910-396-7271

Provider Business Practice Location Address
First Line	:	2864 WOODRUFF STREET
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28307
Country	:	US
Telephone Number	:	910-570-3113
Fax Number	:	910-396-7271

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	01/19/2024

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