# EBON ANTHONY BOURNE MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043494479
- **Authorized official:** DR. EBON ANTHONY BOURNE MD (MD/OWNER)
- **Authorized official phone:** (954) 895-8240

## Contact information

- **Practice address:** 2594 WEDDINGTON RDG NE, MARIETTA, GA 30068-2283
- **Practice address phone:** (954) 895-8240
- **Practice address fax:** (678) 504-5346
- **Mailing address:** 2595 WEDDINGTON RIDGE, MARIETTA, GA 30068
- **Mailing address phone:** (954) 895-8240
- **Mailing address fax:** (678) 504-5346

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | ME84326 | FL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | 68373 | GA | Yes |

## Other

- **Enumeration date:** 12/20/2007
- **Last updated:** 03/20/2015