Provider Demographics
NPI:1538523964
Name:BUSH, CHRISTOPHER BRYAN (NP-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:BRYAN
Last Name:BUSH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 SATELLITE BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-9009
Mailing Address - Country:US
Mailing Address - Phone:678-257-2547
Mailing Address - Fax:404-795-5832
Practice Address - Street 1:1720 PHOENIX BLVD STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5596
Practice Address - Country:US
Practice Address - Phone:678-257-2547
Practice Address - Fax:404-795-5832
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003176779DMedicaid
GA003176779AMedicaid
GA003176779CMedicaid
GA003176779BMedicaid
GA003176779DMedicaid