Provider Demographics
NPI:1942327556
Name:TOMMY A. BOONE, PC
Entity Type:Organization
Organization Name:TOMMY A. BOONE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-313-3549
Mailing Address - Street 1:165 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2334
Mailing Address - Country:US
Mailing Address - Phone:678-313-3549
Mailing Address - Fax:
Practice Address - Street 1:1 DUNWOODY PARK
Practice Address - Street 2:SUITE 140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7404
Practice Address - Country:US
Practice Address - Phone:770-932-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL136144550AMedicaid