Healthcare Provider Details

I. General information

NPI: 1568419471
Provider Name (Legal Business Name): WILLIAM BRADLEY BOYD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1485 JESSE JEWELL PKWY NE STE 200A
GAINESVILLE GA
30501-3806
US

IV. Provider business mailing address

1485 JESSE JEWELL PKWY NE STE 200A
GAINESVILLE GA
30501-3806
US

V. Phone/Fax

Practice location:
  • Phone: 770-534-5255
  • Fax: 770-287-3871
Mailing address:
  • Phone: 770-534-5255
  • Fax: 770-287-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number68375
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number68375
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: