Provider Demographics
NPI:1992888960
Name:BOONE, ARLIE GORDON (MD)
Entity type:Individual
Prefix:DR
First Name:ARLIE
Middle Name:GORDON
Last Name:BOONE
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:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1500
Mailing Address - Country:US
Mailing Address - Phone:912-384-3838
Mailing Address - Fax:912-384-8847
Practice Address - Street 1:102 BOWENS MILL RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2250
Practice Address - Country:US
Practice Address - Phone:912-384-3838
Practice Address - Fax:912-384-8847
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39442Medicare UPIN