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EBON ANTHONY BOURNE MD PA
NPI 1043494479
Clinic/Center - Multi-Specialty in Marietta, GA

Active since December 20, 2007
2594 WEDDINGTON RDG NE, MARIETTA, GA 30068(954) 895-8240(678) 504-5346 Get Directions Write a Review

NPPES record last updated: March 20, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Ebon Anthony Bourne Md Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBON ANTHONY BOURNE MD PA (NPI 1043494479) is a healthcare organization registered as a multi-specialty in Marietta, Georgia and active in the NPI registry since December 2007. The organization lists Ebon Anthony Bourne, Md/owner, as its authorized official.

NPPES Registry Identity

NPI1043494479
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameEBON ANTHONY BOURNE MD PA
Location Address2594 WEDDINGTON RDG NEMarietta, GA 30068-2283
Mailing Address2595 Weddington RidgeMarietta, GA 30068 · (954) 895-8240 · Fax (678) 504-5346
Phone(954) 895-8240
Fax(678) 504-5346
Organization SubpartNo
Authorized OfficialEbon Anthony BourneMd/owner · (954) 895-8240
Enumeration DateDecember 20, 2007
Last NPPES UpdateMarch 20, 2015
✔ NPI 1043494479 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
License✔ Licensed in GA · 68373
Also ListedInternal MedicineTaxonomy 207R00000X · License ME84326 (FL)
2594 WEDDINGTON RDG NE, Marietta, GA 30068
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Other Identifiers 3

Medicare UPINH63877FL
Medicare PINK8095FL
Medicaid265092400FL

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ebon Anthony Bourne MD PA's NPI number?

The NPI number for Ebon Anthony Bourne MD PA is 1043494479. It was assigned to this organization in the NPPES registry on December 20, 2007.

Where is Ebon Anthony Bourne MD PA located?

Ebon Anthony Bourne MD PA is located at 2594 Weddington Rdg NE, Marietta, GA 30068. The listed phone number is (954) 895-8240.

What is Ebon Anthony Bourne MD PA's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

When was this NPI record last updated?

The NPPES record for Ebon Anthony Bourne MD PA was last updated on March 20, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.