Provider Demographics
NPI:1023115565
Name:BUSH, WILLIAM GARNER (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GARNER
Last Name:BUSH
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 1:1020 RIVER OAKS DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9500
Mailing Address - Country:US
Mailing Address - Phone:601-664-0111
Mailing Address - Fax:601-932-1308
Practice Address - Street 1:1020 RIVER OAKS DR
Practice Address - Street 2:SUITE 410
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39232-9500
Practice Address - Country:US
Practice Address - Phone:601-664-0111
Practice Address - Fax:601-932-1308
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11010207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS11010OtherSTATE MEDICAL LICENSURE
MS00121297Medicaid
MSBB0532829OtherDEA REGISTRATION NUMBER
MS00121297Medicaid