Provider Demographics
NPI:1508600016
Name:BOYD, JUSTIN WESLEY
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WESLEY
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11602 JAYMAN DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-4222
Mailing Address - Country:US
Mailing Address - Phone:919-737-3351
Mailing Address - Fax:
Practice Address - Street 1:11602 JAYMAN DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-4222
Practice Address - Country:US
Practice Address - Phone:919-737-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23892604172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver