Provider Demographics
NPI:1861017139
Name:BOHANAN, MAC (MD)
Entity type:Individual
Prefix:
First Name:MAC
Middle Name:
Last Name:BOHANAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 CENTERVILLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4675
Mailing Address - Country:US
Mailing Address - Phone:850-878-8121
Mailing Address - Fax:509-426-5158
Practice Address - Street 1:1401 CENTERVILLE RD STE 600
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4661
Practice Address - Country:US
Practice Address - Phone:850-878-8121
Practice Address - Fax:850-942-6515
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2025-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA119882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology