Basic Information
| Provider Information | |||||||||
| NPI: | 1558781955 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSSCHER | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | JERRETT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365 CLIFTON RD NE STE 4400 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785163 | ||||||||
| FaxNumber: | 4047785128 | ||||||||
| Practice Location | |||||||||
| Address1: | 1365 CLIFTON RD NE STE 4400 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785163 | ||||||||
| FaxNumber: | 4047785128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2014 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207WX0120X | 80345 | GA | N | 207W00000X | 080345 | GA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.