Provider Demographics
NPI:1699390369
Name:BUSBEE, CAROLINE GRACE (PA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:GRACE
Last Name:BUSBEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD STE 4101
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4542
Mailing Address - Country:US
Mailing Address - Phone:770-831-5525
Mailing Address - Fax:
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY STE 1401
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30024-6098
Practice Address - Country:US
Practice Address - Phone:706-248-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9822363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant