Provider Demographics
NPI:1598033029
Name:BAHNSON, GRAHM G (DPM)
Entity Type:Individual
Prefix:DR
First Name:GRAHM
Middle Name:G
Last Name:BAHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3071 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:#110
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8641
Mailing Address - Country:US
Mailing Address - Phone:770-232-9778
Mailing Address - Fax:
Practice Address - Street 1:3025 MAPLE DR NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2618
Practice Address - Country:US
Practice Address - Phone:404-231-1227
Practice Address - Fax:404-364-0834
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001245213E00000X, 213EP1101X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2021485406Medicare PIN