Provider Demographics
NPI:1730074337
Name:STACY, TINA BOYD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TINA
Middle Name:BOYD
Last Name:STACY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4465 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-9317
Mailing Address - Country:US
Mailing Address - Phone:404-425-4474
Mailing Address - Fax:
Practice Address - Street 1:4465 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-9317
Practice Address - Country:US
Practice Address - Phone:404-425-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0195601835X0200X
VA02020113581835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology