Provider Demographics
NPI:1033198338
Name:LEBOYD, NICHOLE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:LEBOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PIEDMONT AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2508
Mailing Address - Country:US
Mailing Address - Phone:404-756-5764
Mailing Address - Fax:404-756-5252
Practice Address - Street 1:75 PIEDMONT AVE STE 700
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2508
Practice Address - Country:US
Practice Address - Phone:404-756-5764
Practice Address - Fax:404-756-5252
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054452207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA083240704BMedicaid
GA083240704CMedicaid