Individual
VALERIE L BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
116 MIMOSA DR, THOMASVILLE, GA 31792-6605
(229) 551-0083
(229) 227-9642
Mailing address
116 MIMOSA DR, THOMASVILLE, GA 31792-6605
(229) 551-0083
(229) 227-9642
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3598
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100000112A
PEACH STATE
GA
05
—
100000112A
—
GA
05
—
100000112B
—
GA
01
—
368501
WELLCARE
GA
01
—
970017094
RAILROAD MEDICARE
GA
Enumeration date
01/13/2006
Last updated
11/16/2020
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