Provider Demographics
NPI:1619199817
Name:CLEMENTS, BOYD MAWHINNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BOYD
Middle Name:MAWHINNEY
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 PLANTERS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-3350
Mailing Address - Country:US
Mailing Address - Phone:434-848-9349
Mailing Address - Fax:434-848-0585
Practice Address - Street 1:1607 PLANTERS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-3350
Practice Address - Country:US
Practice Address - Phone:434-848-9349
Practice Address - Fax:434-848-0585
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABO7581Medicare UPIN