MEDICARE: STEPHANIE ANNE BOYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-3-19862	OH
2	183500000X	Pharmacist	019531	GA

General Provider Information

NPI Number	:	1922631571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ANNE BOYD

Provider Business Mailing Address
First Line	:	2395 NORTHLAKE CT NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2223
Country	:	US
Telephone Number	:	678-575-2197
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 LAVISTA RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3951
Country	:	US
Telephone Number	:	404-633-4201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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