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General NPI Number Information
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NPI Number | 1306407770
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Entity Type | Individual
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Provider Name | MONTEAGER LASHA BOYD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/26/2019
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Provider Practice Location Address
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Address Line | 750 RIVERSIDE DR
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City | MACON
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State | GA
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Zip | 31201-2611
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Country | US
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Telephone | 478-477-3813
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Fax |
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Provider Business Mailing Address
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Address Line | 2042 RESERVE PKWY
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City | MCDONOUGH
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State | GA
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Zip | 30253-7433
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Country | US
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Telephone | 440-865-9447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW007009
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License Number State | GA
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