OrganizationActive
Ebon Anthony Bourne MD PA
NPI 1043494479 · Multi-Specialty Clinic/Center · Marietta, GA
Provider details
- NPI number
- 1043494479
- Entity type
- Organization
- Primary specialty
- Multi-Specialty Clinic/CenterAmbulatory Health Care Facilities
- Authorized official
- Ebon Bourne, Md/Owner
- License
- ME84326 (FL)
Practice location
2594 Weddington Rdg Ne
Marietta, GA 30068-2283
Phone: (954) 895-8240
Fax: (678) 504-5346
Mailing address
2595 Weddington Ridge
Marietta, GA 30068
Registry dates
- Enumerated
- 2007-12-20
- Last updated
- 2015-03-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.