Provider Demographics
NPI:1851913651
Name:BUSHONG, GRACE ASHLEY (PA)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ASHLEY
Last Name:BUSHONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:GRACE
Other - Middle Name:ASHLEY
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3127 ROCK PORT CIR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2742
Mailing Address - Country:US
Mailing Address - Phone:678-906-9334
Mailing Address - Fax:
Practice Address - Street 1:115 CHERRY ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7205
Practice Address - Country:US
Practice Address - Phone:770-793-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant