MEDICARE: NICHOLE MARIE LEBOYD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	054452	GA
2	207Q00000X	Family Medicine Physician	054452	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033198338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE MARIE LEBOYD MD

Provider Business Mailing Address
First Line	:	75 PIEDMONT AVE STE 700
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-2508
Country	:	US
Telephone Number	:	404-756-5764
Fax Number	:	404-756-5252

Provider Business Practice Location Address
First Line	:	75 PIEDMONT AVE STE 700
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-2508
Country	:	US
Telephone Number	:	404-756-5764
Fax Number	:	404-756-5252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/03/2008

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