Provider Demographics
NPI:1649358961
Name:BHUSHAN, ANJU (MD)
Entity type:Individual
Prefix:
First Name:ANJU
Middle Name:
Last Name:BHUSHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 N POINT PKWY
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4248
Mailing Address - Country:US
Mailing Address - Phone:678-205-9004
Mailing Address - Fax:678-205-9005
Practice Address - Street 1:3890 JOHNS CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1285
Practice Address - Country:US
Practice Address - Phone:770-622-9002
Practice Address - Fax:770-622-9004
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH00715Medicare UPIN
GA11BDTBCMedicare PIN