Provider Demographics
NPI:1922707025
Name:BOYD, TANYA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HOGANSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-1422
Mailing Address - Country:US
Mailing Address - Phone:706-812-2852
Mailing Address - Fax:
Practice Address - Street 1:129 TAYLOR LEN DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-8541
Practice Address - Country:US
Practice Address - Phone:706-616-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty