MEDICARE: TOMMY GENE BOURGEOIS II PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	4366	TN

General Provider Information

NPI Number	:	1033715610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMMY GENE BOURGEOIS II PA-C

Provider Business Mailing Address
First Line	:	1624 RIVERSIDE DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37216-4012
Country	:	US
Telephone Number	:	985-870-1041
Fax Number	:

Provider Business Practice Location Address
First Line	:	5020 CAROTHERS PKWY
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-6009
Country	:	US
Telephone Number	:	615-685-7086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	01/13/2026

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