Provider Demographics
NPI:1578500591
Name:BUSH, STANLEY SETH III (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:SETH
Last Name:BUSH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508B HARDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1416
Mailing Address - Country:US
Mailing Address - Phone:478-741-7337
Mailing Address - Fax:478-741-7371
Practice Address - Street 1:1508B HARDEMAN AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1416
Practice Address - Country:US
Practice Address - Phone:478-741-7337
Practice Address - Fax:478-741-7371
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582566360OtherCIGNA HEALTHCARE
GA582566360OtherUNITED HEALTHCARE
GA582566360OtherAETNA
GA582566360OtherMAILHANDLERS
GA582566360OtherSTATE HEALTH BENEFIT PLAN
GA582566360OtherSECURE HEALTH PLANS
GA582566360OtherCORE ADMINISTRATIVE SVCS
GA000872737AMedicaid
GA582566360OtherBCBS