Provider Demographics
NPI:1427807197
Name:BOYKIN, THERON
Entity type:Individual
Prefix:
First Name:THERON
Middle Name:
Last Name:BOYKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 KANAWHA TRL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-2138
Mailing Address - Country:US
Mailing Address - Phone:404-668-4847
Mailing Address - Fax:
Practice Address - Street 1:1772 KANAWHA TRL
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-2138
Practice Address - Country:US
Practice Address - Phone:404-668-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide