Provider Demographics
NPI:1720634504
Name:BOYD, LEO
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:
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 1:2144 CUMBERLAND CITY RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-6175
Mailing Address - Country:US
Mailing Address - Phone:931-827-2017
Mailing Address - Fax:
Practice Address - Street 1:2144 CUMBERLAND CITY RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-6175
Practice Address - Country:US
Practice Address - Phone:931-827-2017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider