Provider Demographics
NPI:1821166240
Name:BHUSHAN, HARSH (MD)
Entity Type:Individual
Prefix:DR
First Name:HARSH
Middle Name:
Last Name:BHUSHAN
Suffix:
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:P O BOX 397
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30459
Mailing Address - Country:US
Mailing Address - Phone:912-871-8000
Mailing Address - Fax:912-871-3030
Practice Address - Street 1:1601 FAIR ROAD
Practice Address - Street 2:#900
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-871-8000
Practice Address - Fax:912-871-3030
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051780207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH43596Medicare UPIN