MEDICARE: BRITTANY BOHANNON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1427540194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY BOHANNON

Provider Business Mailing Address
First Line	:	2950 LAUREL LN
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-2312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 FOREST PKWY
Second Line	:
City	:	FOREST PARK
State	:	GA
Zip	:	30297-2308
Country	:	US
Telephone Number	:	678-509-3690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	05/30/2018

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Directions to “ BRITTANY BOHANNON ” Practice Location

Language	Start Address	Practice Location

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