Organization · Type 2 NPI
Ebon Anthony Bourne MD PA
Multi-Specialty Clinic/Center · Marietta, GA
NPI number
1043494479
Active
Practice location
2594 Weddington Rdg NE
Marietta, GA 30068-2283
Fax (678) 504-5346
Mailing address
2595 Weddington Ridge
Marietta, GA 30068
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Internal Medicine Physician | 207R00000X | ME84326 (FL) |
| Multi-Specialty Clinic/Center Primary | 261QM1300X | 68373 (GA) |
Multi-Specialty Clinic/Center: Definition to come...
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About NPI 1043494479
Ebon Anthony Bourne MD PA's National Provider Identifier is 1043494479, issued on Dec 20, 2007. The primary taxonomy on file is Multi-Specialty Clinic/Center (261QM1300X), and the practice location is in Marietta, GA. The record was last updated on Mar 20, 2015.