Provider Demographics
NPI:1316010077
Name:BOYNTON, RALPH DEWEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:DEWEY
Last Name:BOYNTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 UPPER HEMBREE ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:770-754-6101
Mailing Address - Fax:770-475-1171
Practice Address - Street 1:1115 UPPER HEMBREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-754-6101
Practice Address - Fax:770-475-1171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001332103TC0700X
GA000252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist