Provider Demographics
NPI:1104400779
Name:BYRD, DARRYL JR
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:BYRD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 PATRIOTS PLACE DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-6033
Mailing Address - Country:US
Mailing Address - Phone:704-743-8392
Mailing Address - Fax:704-559-3468
Practice Address - Street 1:2801 CRISMAN ST STE 101E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-3847
Practice Address - Country:US
Practice Address - Phone:704-743-8392
Practice Address - Fax:704-559-3468
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NCHC6001253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health