Healthcare Provider Details

I. General information

NPI: 1558709311
Provider Name (Legal Business Name): ALLISON BOYD MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MARIETTA HWY STE. 630-132
ROSWELL GA
30075-6755
US

IV. Provider business mailing address

880 MARIETTA HWY STE. 630-132
ROSWELL GA
30075-6755
US

V. Phone/Fax

Practice location:
  • Phone: 678-637-7293
  • Fax:
Mailing address:
  • Phone: 678-637-7293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: