Provider Demographics
NPI:1821226333
Name:BUSH, DEMARCUS FITZGERALD (AUD)
Entity Type:Individual
Prefix:DR
First Name:DEMARCUS
Middle Name:FITZGERALD
Last Name:BUSH
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 NEWBURGH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3025
Mailing Address - Country:US
Mailing Address - Phone:803-546-7599
Mailing Address - Fax:
Practice Address - Street 1:300 COLLEGE STREET NE
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29117
Practice Address - Country:US
Practice Address - Phone:803-536-8594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3908231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist