EBON ANTHONY BOURNE MD PA
Ambulatory Health at Weddington Rdg, Marietta, GA

License number
Georgia ME84326
Category
Osteopathic Medicine
Type
Internal Medicine
License number
Georgia 68373
Category
Ambulatory Health
Type
Multi-Specialty
Owner
Name: DR. EBON ANTHONY BOURNE MD
Title: MD/OWNER
Phone: (954) 895-8240
Address
Address
2594 Weddington Rdg NE, Marietta, GA 30068
National Provider ID: 1043494479
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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EBON ANTHONY BOURNE MD, PA

Fort Lauderdale, FL  -  Marietta, GA

Status:
Inactive
Industry:
Medical Doctor's Office
Inactive reason:
Admin Dissolution For Annual Report
Registration:
Oct 18, 2004
Inactive since:
Sep 27, 2013
Addresses:
201 NW 82 Ave 302, Fort Lauderdale, FL 33324 (Physical)
201 NW 82 Ave, Fort Lauderdale, FL 33324
5960 E Grand Duke Cir, Fort Lauderdale, FL 33321
2594 Weddington Rdg NE, Marietta, GA 30068
State ID:
P04000143186
Business type:
Florida Profit Corporation
President, Director:
Ebon A Bourne President, Director, inactive, 201 NW 82 Ave SUITE 301, Fort Lauderdale, FL 33324 (Physical)
Agent:
Kc Caldwell Cpa,7501 NW 4 St, Fort Lauderdale, FL 33317 (Physical)
EIN:
20-1775330

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