Provider Demographics
NPI:1033972211
Name:BOYD, KELSIE D
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:D
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BARONE AVE NE APT 4201
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1862
Mailing Address - Country:US
Mailing Address - Phone:470-844-3834
Mailing Address - Fax:
Practice Address - Street 1:5415 SUGARLOAF PKWY STE 2208
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7832
Practice Address - Country:US
Practice Address - Phone:770-676-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program