Provider Demographics
NPI:1750177101
Name:BUSH, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:BUSH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 MORNINGCREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-2813
Mailing Address - Country:US
Mailing Address - Phone:678-614-4565
Mailing Address - Fax:
Practice Address - Street 1:4651 WOODSTOCK RD STE 208-278
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1698
Practice Address - Country:US
Practice Address - Phone:770-637-9757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications