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NPI Code Detail

MEDICARE: MAC BOHANAN MD

MEDICARE: MAC BOHANAN MD
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
12084N0400XNeurology Physician11988GA

General Provider Information

NPI Number : 1861017139
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAC BOHANAN MD
Provider Business Mailing Address
First Line : 1401 CENTERVILLE RD STE 300
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4675
Country : US
Telephone Number : 850-878-8121
Fax Number : 509-426-5158
Provider Business Practice Location Address
First Line : 1401 CENTERVILLE RD STE 600
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4661
Country : US
Telephone Number : 850-878-8121
Fax Number : 850-942-6515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2020
Last Update Date : 08/15/2025

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Directions to “ MAC BOHANAN MD” Practice Location

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