Provider Demographics
NPI:1205268273
Name:BOHANAN, SHAWN (BCBA)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BOHANAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 AUGUSTA WEST PKWY STE 1B
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1808
Mailing Address - Country:US
Mailing Address - Phone:706-826-2770
Mailing Address - Fax:706-826-2771
Practice Address - Street 1:1212 AUGUSTA WEST PKWY STE 1B
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1808
Practice Address - Country:US
Practice Address - Phone:706-826-2770
Practice Address - Fax:706-826-2771
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst