Healthcare Provider Details

I. General information

NPI: 1083211486
Provider Name (Legal Business Name): WILLIAM CODY BYRD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15441 US HIGHWAY 17 STE 501
HAMPSTEAD NC
28443-0016
US

IV. Provider business mailing address

85 E HENNINGS WAY
HAMPSTEAD NC
28443-3040
US

V. Phone/Fax

Practice location:
  • Phone: 910-685-7307
  • Fax:
Mailing address:
  • Phone: 256-453-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113755
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8956
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: