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General NPI Number Information
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NPI Number | 1548245913
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Entity Type | Individual
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Provider Name | ERIC STEVEN BOUR MD
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Gender | Male
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 1010 PRINCE AVE STE 300
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City | ATHENS
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State | GA
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Zip | 30606-5805
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Country | US
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Telephone | 706-425-1470
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Fax | 706-425-1471
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Provider Business Mailing Address
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Address Line | 1010 PRINCE AVE STE 400
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City | ATHENS
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State | GA
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Zip | 30606-5812
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Country | US
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Telephone | 706-425-1400
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Fax | 706-548-0184
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 79719
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 079719
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License Number State | GA
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