Provider Demographics
NPI:1518076736
Name:BUSH, DWANA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DWANA
Middle Name:M
Last Name:BUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:755 MOUNT VERNON HWY NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4274
Mailing Address - Country:US
Mailing Address - Phone:404-255-5774
Mailing Address - Fax:404-255-5994
Practice Address - Street 1:755 MOUNT VERNON HWY NE
Practice Address - Street 2:SUITE 350
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4274
Practice Address - Country:US
Practice Address - Phone:404-255-5774
Practice Address - Fax:404-255-5994
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA024784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBXF2Medicare ID - Type Unspecified
D39522Medicare UPIN