Provider Demographics
NPI:1376684498
Name:BOYD, GEORGE (MDIV)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LORIDANS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3512
Mailing Address - Country:US
Mailing Address - Phone:404-550-3605
Mailing Address - Fax:404-688-2100
Practice Address - Street 1:258 AUBURN AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2646
Practice Address - Country:US
Practice Address - Phone:404-550-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4-0028171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator