| Ebon Anthony Bourne Md Pa | |
|
2594 Weddington Rdg Ne Marietta GA 30068-2283 | |
| (954) 895-8240 | |
| (678) 504-5346 |
| Full Name | Ebon Anthony Bourne Md Pa |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2594 Weddington Rdg Ne, Marietta, Georgia |
| Authorized Official Name and Position | Ebon Anthony Bourne (MD/OWNER) |
| Authorized Official Contact | 9548958240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebon Anthony Bourne Md Pa 2595 Weddington Ridge Marietta GA 30068 Ph: (954) 895-8240 | Ebon Anthony Bourne Md Pa 2594 Weddington Rdg Ne Marietta GA 30068-2283 Ph: (954) 895-8240 |
| NPI Number | 1043494479 |
|---|---|
| Provider Enumeration Date | 12/20/2007 |
| Last Update Date | 03/20/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043494479 | NPI | - | NPPES |
| 265092400 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME84326 (Florida) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | 68373 (Georgia) | Primary |
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