Provider Demographics
NPI:1770374696
Name:BOHANNON, JEFFREY R
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:BOHANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 W GRIFFIN CT
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-4658
Mailing Address - Country:US
Mailing Address - Phone:615-818-7167
Mailing Address - Fax:
Practice Address - Street 1:408 W GRIFFIN CT
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-4658
Practice Address - Country:US
Practice Address - Phone:615-818-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)