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General NPI Number Information
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NPI Number | 1922631571
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Entity Type | Individual
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Provider Name | STEPHANIE ANNE BOYD
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Gender | Female
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 2205 LAVISTA RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-3951
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Country | US
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Telephone | 404-633-4201
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Fax |
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Provider Business Mailing Address
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Address Line | 2395 NORTHLAKE CT NE
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City | ATLANTA
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State | GA
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Zip | 30345-2223
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Country | US
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Telephone | 678-575-2197
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 03-3-19862
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 019531
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License Number State | GA
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