MEDICARE: DR. GERALD WAYNE BOHANAN 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	261QR0200X	Radiology Clinic/Center	10105	GA

General Provider Information

NPI Number	:	1871747022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD WAYNE BOHANAN M.D.

Provider Business Mailing Address
First Line	:	1415 PARK AVE
Second Line	:
City	:	PERRY
State	:	GA
Zip	:	31069-2311
Country	:	US
Telephone Number	:	478-987-3417
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 WATSON BLVD
Second Line	:	SUITE D
City	:	WARNER ROBINS
State	:	GA
Zip	:	31093-2997
Country	:	US
Telephone Number	:	478-953-6033
Fax Number	:	478-953-6047

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	06/14/2026

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