Provider Demographics
NPI:1639688997
Name:BOHANNAN, COLLEEN JOANNE (ATC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:JOANNE
Last Name:BOHANNAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 LANGSTON CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-2478
Mailing Address - Country:US
Mailing Address - Phone:707-853-3295
Mailing Address - Fax:
Practice Address - Street 1:352 LANGSTON CHAPEL RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-2478
Practice Address - Country:US
Practice Address - Phone:707-853-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer