Provider Demographics
NPI:1679598783
Name:BOYD, COLEMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:COLEMAN
Middle Name:A
Last Name:BOYD
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 1:1635 N DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:BOLTON
Mailing Address - State:MS
Mailing Address - Zip Code:39041-9588
Mailing Address - Country:US
Mailing Address - Phone:601-954-5954
Mailing Address - Fax:
Practice Address - Street 1:1635 N DAVIS RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MS
Practice Address - Zip Code:39041-9588
Practice Address - Country:US
Practice Address - Phone:601-954-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17600208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice