Provider Demographics
NPI:1326099060
Name:G.B. MEDICAL ASSOICATES, INC.
Entity Type:Organization
Organization Name:G.B. MEDICAL ASSOICATES, INC.
Other - Org Name:TULLAHOMA ADVANCED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONNAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-393-2245
Mailing Address - Street 1:601 NW ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3536
Mailing Address - Country:US
Mailing Address - Phone:931-393-2245
Mailing Address - Fax:931-393-2247
Practice Address - Street 1:601 NW ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3536
Practice Address - Country:US
Practice Address - Phone:931-393-2245
Practice Address - Fax:931-393-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4124529OtherBCBS
TN10071451OtherAMERIGROUP
TN1326099060OtherNPI
TN3733675Medicaid
TN=========OtherCOMMERICAL AND OTHER
TN10071451OtherAMERIGROUP