Healthcare Provider Details

I. General information

NPI: 1619950466
Provider Name (Legal Business Name): GEORGE BONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 N ELLINGTON PKWY SUITE 201
LEWISBURG TN
37091-2227
US

IV. Provider business mailing address

1080 N ELLINGTON PKWY
LEWISBURG TN
37091-2227
US

V. Phone/Fax

Practice location:
  • Phone: 931-359-4074
  • Fax: 931-270-3697
Mailing address:
  • Phone: 931-359-4074
  • Fax: 931-270-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0000016174
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: