EBON ANTHONY BOURNE MD PA NPI 1043494479

NPI Information

NPI: 1043494479
Provider Name: EBON ANTHONY BOURNE MD PA
Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

Address:
2594 WEDDINGTON RDG NE
MARIETTA, GA
ZIP 30068
Phone: (954) 895-8240
Get Directions

EBON ANTHONY BOURNE MD PA is a multi-specialty clinic center in Marietta, GA. EBON ANTHONY BOURNE MD PA NPI is 1043494479. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2594 WEDDINGTON RDG NE
MARIETTA, GA
ZIP 30068-283
Phone: (954) 895-8240
Fax: (678) 504-5346

The provider's authorized official is Ebon Anthony Bourne .
The authorized official title is Md/owner and has the following contact phone number (954) 895-8240.

The enumeration date for this NPI number is 12/20/2007 and was last updated on 3/20/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207R00000X	Internal Medicine		ME84326	FLORIDA	No
2	261QM1300X	Clinic/Center	Multi-Specialty	68373	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	H63877	MEDICARE UPIN	FLORIDA
2	K8095	MEDICARE PIN	FLORIDA
3	265092400	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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