Organization
EBON ANTHONY BOURNE MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EBON ANTHONY BOURNE MD (MD/OWNER)
(954) 895-8240
Entity
Organization
Contact information
Practice address
2594 WEDDINGTON RDG NE, MARIETTA, GA 30068-2283
(954) 895-8240
(678) 504-5346
Mailing address
2595 WEDDINGTON RIDGE, MARIETTA, GA 30068
(954) 895-8240
(678) 504-5346
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME84326
FL
261QM1300X
Multi-Specialty Clinic/Center
Primary
68373
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265092400
—
FL
Enumeration date
12/20/2007
Last updated
03/20/2015
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