Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1104495217 |
---|---|
Provider Name | Divonia Boyd |
First Address | Duluth, GA 30096-3186 |
Second Address | Duluth, GA 30096-3186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2021 |
Last Update Date | 22/06/2021 |