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General NPI Number Information
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NPI Number | 1821633629
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Entity Type | Individual
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Provider Name | ANDREW MICHAEL BOHUNICKY PA
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Gender | Male
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 4085 MALLORY LN STE 200
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City | FRANKLIN
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State | TN
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Zip | 37067-8291
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Country | US
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Telephone | 615-721-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 2600 NAPA VALLEY WAY APT 31
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City | COLUMBIA
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State | TN
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Zip | 38401-5138
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Country | US
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Telephone | 607-425-9251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-09487
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License Number State | NC
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