Individual
MR. ROGER JAMES BANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR, CHT
Contact information
Practice address
3645 GENTIAN BLVD, SUITE 1, COLUMBUS, GA 31907-5687
(706) 507-4433
Mailing address
3645 GENTIAN BLVD, SUITE 1, COLUMBUS, GA 31907-5687
(706) 507-4433
Taxonomy
Speciality
Code
Description
License number
State
225XH1200X
Hand Occupational Therapist
Primary
OT002316
GA
Other
Enumeration date
12/16/2009
Last updated
12/16/2009
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