Provider Demographics
NPI:1609834688
Name:BOYD, AUDREY RHODES (MD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:RHODES
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SAGEFIRE CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9199
Mailing Address - Country:US
Mailing Address - Phone:803-732-5990
Mailing Address - Fax:803-737-5369
Practice Address - Street 1:2200 HARDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7107
Practice Address - Country:US
Practice Address - Phone:803-737-5300
Practice Address - Fax:803-737-5369
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC104791Medicaid
SCAA43845953Medicare UPIN
SCD055935953Medicare PIN
SCD055933354Medicare PIN
SC104791Medicaid