Provider Demographics
NPI:1033715610
Name:BOURGEOIS, TOMMY GENE II (PA-C)
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:GENE
Last Name:BOURGEOIS
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 SUNDOWN DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-6913
Mailing Address - Country:US
Mailing Address - Phone:985-870-1041
Mailing Address - Fax:
Practice Address - Street 1:2235 E MCEWEN DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1470
Practice Address - Country:US
Practice Address - Phone:405-285-5664
Practice Address - Fax:405-285-6684
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4366363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant