Healthcare Provider Details

I. General information

NPI: 1750331542
Provider Name (Legal Business Name): GAYLYN MCILWAIN HORNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7067 VETERANS PARKWAY SUITE 210
PELL CITY AL
35125
US

IV. Provider business mailing address

7067 VETERANS PKWY STE 210
PELL CITY AL
35125-5128
US

V. Phone/Fax

Practice location:
  • Phone: 205-405-7348
  • Fax: 205-338-0550
Mailing address:
  • Phone: 205-405-7348
  • Fax: 205-338-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD.24389
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: