Provider Demographics
NPI:1225141997
Name:BOHLKE, WILLIAM SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
Last Name:BOHLKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 NORTH PARKER AVENUE
Mailing Address - Street 2:PO BOX 487
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-0487
Mailing Address - Country:US
Mailing Address - Phone:912-842-2101
Mailing Address - Fax:912-842-2103
Practice Address - Street 1:128 NORTH PARKER AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415-0487
Practice Address - Country:US
Practice Address - Phone:912-842-2101
Practice Address - Fax:912-842-2103
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037490207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00593557DMedicaid
08BDQBKMedicare ID - Type Unspecified
GAF76385Medicare UPIN