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General NPI Number Information
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NPI Number | 1659315612
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Entity Type | Individual
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Provider Name | MICHAEL BOYD PA
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 1800 HOG MOUNTAIN RD BLDG 100, STE 103
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City | WATKINSVILLE
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State | GA
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Zip | 30677
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Country | US
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Telephone | 770-910-2278
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 HOG MOUNTAIN RD BLDG 100, STE 103
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7289
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Country | US
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Telephone | 770-910-2278
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 003638
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License Number State | GA
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