MEDICARE: DR. WILLIAM B BOHANNON DO

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	207Q00000X	Family Medicine Physician	D0818	AL
2	207Q00000X	Family Medicine Physician	92783	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	051527910	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1467439133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM B BOHANNON DO

Provider Business Mailing Address
First Line	:	1497 LAFAYETTE PKWY
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-2552
Country	:	US
Telephone Number	:	706-803-8190
Fax Number	:

Provider Business Practice Location Address
First Line	:	1497 LAFAYETTE PKWY
Second Line	:
City	:	LAGRANGE
State	:	GA
Zip	:	30241-2552
Country	:	US
Telephone Number	:	706-803-8190
Fax Number	:

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	03/21/2025

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