Provider Demographics
NPI:1710174305
Name:BUSTON, JAMESON GEORGE II (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMESON
Middle Name:GEORGE
Last Name:BUSTON
Suffix:II
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 1:4121 COX RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3321
Mailing Address - Country:US
Mailing Address - Phone:804-545-1920
Mailing Address - Fax:804-545-1656
Practice Address - Street 1:13540 HULL STREET RD
Practice Address - Street 2:SUITE 110
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2107
Practice Address - Country:US
Practice Address - Phone:804-739-6142
Practice Address - Fax:804-739-8923
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN