MEDICARE: TOMMY A. BOONE, PC

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	101YP2500X	Professional Counselor	02955	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942327556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOMMY A. BOONE, PC

Provider Business Mailing Address
First Line	:	165 ROBERTS RD
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-2334
Country	:	US
Telephone Number	:	678-313-3549
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 DUNWOODY PARK
Second Line	:	SUITE 140
City	:	ATLANTA
State	:	GA
Zip	:	30338-7404
Country	:	US
Telephone Number	:	770-932-7000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TOMMY AARON BOONE
Credential	:	LPC
Telephone Number	:	678-313-3549

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	09/03/2013

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