Healthcare Provider Details

I. General information

NPI: 1376677641
Provider Name (Legal Business Name): RANDALL JAMES BOYD D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3005 HOLLY SPRINGS PKWY SUITE 103
HOLLY SPRINGS GA
30115-7400
US

IV. Provider business mailing address

730 DENA DR
CANTON GA
30114-7155
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-6332
  • Fax:
Mailing address:
  • Phone: 770-704-6332
  • Fax: 770-704-6332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIRO007076
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: