Healthcare Provider Details

I. General information

NPI: 1336095769
Provider Name (Legal Business Name): DYLAN RILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3368 HIGHWAY 280 STE 116
ALEXANDER CITY AL
35010-3375
US

IV. Provider business mailing address

3368 HIGHWAY 280 STE 116
ALEXANDER CITY AL
35010-3375
US

V. Phone/Fax

Practice location:
  • Phone: 256-329-7100
  • Fax:
Mailing address:
  • Phone: 256-329-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2899
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: