Provider Demographics
NPI:1578833422
Name:GLENN H BOYD MD PC
Entity Type:Organization
Organization Name:GLENN H BOYD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-278-0022
Mailing Address - Street 1:1203 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2571
Mailing Address - Country:US
Mailing Address - Phone:706-278-0022
Mailing Address - Fax:706-278-6360
Practice Address - Street 1:1203 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2530
Practice Address - Country:US
Practice Address - Phone:706-278-0022
Practice Address - Fax:706-278-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty