Individual
STACIE BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
418 N BALDWIN CIR, SAVANNAH, GA 31405-3967
(912) 323-1674
Mailing address
418 N BALDWIN CIR, SAVANNAH, GA 31405-3967
(912) 323-1674
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
GA
Other
Enumeration date
07/27/2023
Last updated
07/27/2023
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