Provider Demographics
NPI:1548457005
Name:BOYD, PHILLIP (CAS)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:BOYD
Suffix:
Gender:M
Credentials:CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6578 HAWKINSVILLE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31216-6836
Mailing Address - Country:US
Mailing Address - Phone:478-238-9805
Mailing Address - Fax:478-225-2197
Practice Address - Street 1:6578 HAWKINSVILLE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31216-6836
Practice Address - Country:US
Practice Address - Phone:478-238-9805
Practice Address - Fax:478-225-2197
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC-4517101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)