Healthcare Provider Details

I. General information

NPI: 1801293220
Provider Name (Legal Business Name): CHRISTINE BOHLEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 EATONTON RD
MADISON GA
30650-4627
US

IV. Provider business mailing address

1550 EATONTON RD
MADISON GA
30650-4627
US

V. Phone/Fax

Practice location:
  • Phone: 706-752-0322
  • Fax: 706-752-0325
Mailing address:
  • Phone: 706-752-0322
  • Fax: 706-752-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN203698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: