Provider Demographics
NPI:1396708558
Name:BYRD, JEFF W (MD)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:W
Last Name:BYRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N BROAD ST
Mailing Address - Street 2:P.O. BOX 2717
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-8132
Mailing Address - Country:US
Mailing Address - Phone:229-228-6496
Mailing Address - Fax:229-228-6510
Practice Address - Street 1:130 N BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-8132
Practice Address - Country:US
Practice Address - Phone:229-228-6496
Practice Address - Fax:229-228-6510
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018100207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00269761AMedicaid
GAE99185Medicare UPIN
GA22CDBDZMedicare ID - Type Unspecified