Provider Demographics
NPI:1831841915
Name:BOYKIN, GREGORY EVAN (BSW)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:EVAN
Last Name:BOYKIN
Suffix:
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 HILTON RD
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-4210
Mailing Address - Country:US
Mailing Address - Phone:469-207-2503
Mailing Address - Fax:
Practice Address - Street 1:6145 TEMPLE STAR RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-8028
Practice Address - Country:US
Practice Address - Phone:463-349-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker