Healthcare Provider Details

I. General information

NPI: 1588581383
Provider Name (Legal Business Name): RENAISSANCE MAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 RIVERSIDE PARK BLVD
MACON GA
31210-1365
US

IV. Provider business mailing address

4030 RIVERSIDE PARK BLVD
MACON GA
31210-1365
US

V. Phone/Fax

Practice location:
  • Phone: 502-468-8534
  • Fax:
Mailing address:
  • Phone: 502-468-8534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TRAVIS BOYD
Title or Position: PLASTIC SURGEON
Credential: MD
Phone: 502-468-8534