Provider Demographics
NPI:1558510453
Name:BYRD, LELAN CLINTON (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAN
Middle Name:CLINTON
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:OR 6000
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-3183
Mailing Address - Fax:
Practice Address - Street 1:840 FLEMING ST
Practice Address - Street 2:STE 1
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791
Practice Address - Country:US
Practice Address - Phone:828-698-0581
Practice Address - Fax:828-698-0583
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA300262084A0401X
NC34262174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD44984Medicare UPIN