Healthcare Provider Details

I. General information

NPI: 1285817577
Provider Name (Legal Business Name): DEVIN A BYRD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 YOUNG WAY
RICHMOND HILL GA
31324-7241
US

IV. Provider business mailing address

23 PLANTATION PARK DR BUILDING 400
BLUFFTON SC
29910-6038
US

V. Phone/Fax

Practice location:
  • Phone: 912-247-8678
  • Fax:
Mailing address:
  • Phone: 912-247-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000873
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: