Katherine Pottinger Bohannon, D.O.
Individual provider Active NPI Pediatrics Physician · Calham, GA
NPI 1669965489 · NPPES record last updated Aug 6, 2021
Key facts
- NPI
- 1669965489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 88717 (GA)
- Practice address
- 204 Professional CT. SE
Calham, GA 30701 - Phone
- (706) 625-5900
- NPI assigned
- Jun 7, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190328002414 | SC | Order and Referring Only - Pediatric Medicine |
3173863107 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 88717 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Agc Pediatrics, LLC | Current |
Accepting new patients | |
| Agc Pediatrics, LLC | Past |
Accepting new patients | |
| Adventist Health System Georgia, Inc. | Past | Accepting new patients |
Locations
204 Professional Ct SE
Calhoun, GA 30701
Phone (706) 625-5900
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/DEJAAA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 010072 | GA | |
| Pediatrics Physician | 208000000X | 88717 | GA | Yes |
Addresses
Primary practice location
204 Professional CT. SE
Calham, GA 30701
Mailing address
204 Professional Court SE
Calham, GA 30701
Phone (706) 766-5643
Other names
- Katherine Pottinger
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.