MEDICARE: ERIC L BOHN M.D.

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	038691	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

General Provider Information

NPI Number	:	1811989320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC L BOHN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	4754 MARTIN RD
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3507
Country	:	US
Telephone Number	:	770-965-0847
Fax Number	:	770-965-0974

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	02/02/2021

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