Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | POD001245 | GA |
N | 222Z00000X | Podiatrist | POD001245 | GA |
N | 213EP1101X | Primary Podiatric Medicine | POD001245 | GA |
Y | 213ES0103X | Foot & Ankle Surgery | POD001245 | GA |
N | 213ES0131X | Foot Surgery | POD001245 | GA |
NPI | 1598033029 |
---|---|
Provider Name | Dr. Grahm G Bahnson |
First Address | Duluth, GA 30097-8641 |
Second Address | Atlanta, GA 30305-2618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2011 |
Last Update Date | 26/09/2019 |