Healthcare Provider Details

I. General information

NPI: 1376170746
Provider Name (Legal Business Name): CATHERINE BOHANNON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE MITCHELL

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 LOWER GATEWAY LOOP UNIT 1633
ORLANDO FL
32827-7213
US

IV. Provider business mailing address

GRAND STRAND MEDICAL CENTER 809 82ND PARKWAY GME OFFICE
MYRTLE BEACH SC
29572
US

V. Phone/Fax

Practice location:
  • Phone: 407-717-4321
  • Fax:
Mailing address:
  • Phone: 843-692-1752
  • Fax: 843-692-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME162652
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: