Provider Demographics
NPI:1215165311
Name:BUSH, SARA BETH (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:BETH
Last Name:BUSH
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 1:1255 E COLLEGE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4553
Mailing Address - Country:US
Mailing Address - Phone:931-424-9388
Mailing Address - Fax:931-424-9208
Practice Address - Street 1:1255 E COLLEGE ST STE 100
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4553
Practice Address - Country:US
Practice Address - Phone:931-424-9388
Practice Address - Fax:931-424-9208
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38170207Q00000X
TN48941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine