Healthcare Provider Details

I. General information

NPI: 1083619951
Provider Name (Legal Business Name): DWAYNE AVANISH NARAYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NORTHWOOD DR
CENTRE AL
35960-1023
US

IV. Provider business mailing address

13894 S BANGERTER PKWY STE 200
DRAPER UT
84020-5320
US

V. Phone/Fax

Practice location:
  • Phone: 256-927-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number81580
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: