Healthcare Provider Details

I. General information

NPI: 1932482122
Provider Name (Legal Business Name): MICHAEL A BOYD MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 1ST AVE
LAWRENCEBURG TN
38464-2704
US

IV. Provider business mailing address

1240 1ST AVE
LAWRENCEBURG TN
38464-2704
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-2332
  • Fax: 931-762-1613
Mailing address:
  • Phone: 931-762-2332
  • Fax: 931-762-1613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44551
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD024363
License Number StateTN

VIII. Authorized Official

Name: MRS. SHERRI KIZER
Title or Position: OFFICE MANAGER
Credential:
Phone: 931-762-2332