Provider Demographics
NPI:1235238239
Name:BOYCE, BRANDON MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MARK
Last Name:BOYCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 W GORDON ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-3480
Mailing Address - Country:US
Mailing Address - Phone:706-647-3030
Mailing Address - Fax:706-647-3033
Practice Address - Street 1:612 W GORDON ST
Practice Address - Street 2:SUITE E
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-3480
Practice Address - Country:US
Practice Address - Phone:706-647-3030
Practice Address - Fax:706-647-3033
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50370174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121667AMedicaid
GA003121667BMedicaid