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General NPI Number Information
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NPI Number | 1033715610
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Entity Type | Individual
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Provider Name | TOMMY GENE BOURGEOIS II PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 5020 CAROTHERS PKWY
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City | FRANKLIN
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State | TN
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Zip | 37067-6009
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Country | US
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Telephone | 615-685-7086
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Fax |
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Provider Business Mailing Address
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Address Line | 1624 RIVERSIDE DR
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City | NASHVILLE
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State | TN
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Zip | 37216-4012
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Country | US
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Telephone | 985-870-1041
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 4366
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License Number State | TN
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