Provider Demographics
NPI:1619950466
Name:BONE, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 N ELLINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-2227
Mailing Address - Country:US
Mailing Address - Phone:931-359-4074
Mailing Address - Fax:931-270-3697
Practice Address - Street 1:1080 N ELLINGTON PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2227
Practice Address - Country:US
Practice Address - Phone:931-359-4074
Practice Address - Fax:931-270-3697
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000016174208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4179082OtherBCBST
TN3283858Medicaid
TN30128101Medicaid
3012819Medicare PIN
30128101Medicare PIN
CH3188Medicare PIN
TN30128101Medicaid
3283858Medicare PIN