Provider Demographics
NPI:1316736531
Name:BOYD, JUSTIN
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:BOYD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 DEOLA DOBBINS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6015
Mailing Address - Country:US
Mailing Address - Phone:901-848-3691
Mailing Address - Fax:
Practice Address - Street 1:3807 DEOLA DOBBINS RD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-6015
Practice Address - Country:US
Practice Address - Phone:901-848-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant