Provider Demographics
NPI:1669965489
Name:BOHANNON, KATHERINE POTTINGER (DO)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:POTTINGER
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:POTTINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:204 PROFESSIONAL COURT SE
Mailing Address - Street 2:
Mailing Address - City:CALHAM
Mailing Address - State:GA
Mailing Address - Zip Code:30701
Mailing Address - Country:US
Mailing Address - Phone:706-766-5643
Mailing Address - Fax:
Practice Address - Street 1:204 PROFESSIONAL CT. SE
Practice Address - Street 2:
Practice Address - City:CALHAM
Practice Address - State:GA
Practice Address - Zip Code:30701
Practice Address - Country:US
Practice Address - Phone:706-625-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010072208000000X
GA88717208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics