Provider Demographics
NPI:1275119257
Name:JOSEPH J BUSCH JR. MD PC
Entity Type:Organization
Organization Name:JOSEPH J BUSCH JR. MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-424-6270
Mailing Address - Street 1:3650 BROOKSIDE PKWY STE 175
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4430
Mailing Address - Country:US
Mailing Address - Phone:770-424-6270
Mailing Address - Fax:770-288-5833
Practice Address - Street 1:3650 BROOKSIDE PKWY STE 175
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4430
Practice Address - Country:US
Practice Address - Phone:770-424-6270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center