Provider Demographics
NPI:1386142743
Name:BOSTICK, JOY LASHUNDA
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:LASHUNDA
Last Name:BOSTICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:LASHUNDA
Other - Last Name:BOSTICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3655 FOREST DOWNS TRCE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-7324
Mailing Address - Country:US
Mailing Address - Phone:678-938-3572
Mailing Address - Fax:
Practice Address - Street 1:1745 PEACHTREE ST NE STE F-102
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2410
Practice Address - Country:US
Practice Address - Phone:678-938-3572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA224456163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse