Provider Demographics
NPI:1073584504
Name:BUSMAN, MICHAEL SHANE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHANE
Last Name:BUSMAN
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:PO BOX 6815
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-6815
Mailing Address - Country:US
Mailing Address - Phone:229-924-2383
Mailing Address - Fax:229-924-0684
Practice Address - Street 1:922 E JEFFERSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4780
Practice Address - Country:US
Practice Address - Phone:229-924-2383
Practice Address - Fax:229-924-0684
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000720893DMedicaid
GA771452OtherBLUE CROSS BLUE SHEILD
GA11SCDHGMedicare ID - Type Unspecified
GA771452OtherBLUE CROSS BLUE SHEILD