Provider Demographics
NPI:1679877328
Name:BROYLES, JOY SHANTEL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:SHANTEL
Last Name:BROYLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2545 LAWRENCEVILLE HWY
Mailing Address - Street 2:STE 300
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3239
Mailing Address - Country:US
Mailing Address - Phone:404-321-1950
Mailing Address - Fax:404-633-9838
Practice Address - Street 1:2545 LAWRENCEVILLE HWY
Practice Address - Street 2:STE 300
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3239
Practice Address - Country:US
Practice Address - Phone:404-321-1950
Practice Address - Fax:404-633-9838
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA007056363A00000X
IL085003939363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant