Healthcare Provider Details

I. General information

NPI: 1922944669
Provider Name (Legal Business Name): SAWYER AGNEW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4830 RUCKER RD
MONETA VA
24121-5281
US

IV. Provider business mailing address

41 DEMRA ST
CHARLESTON WV
25320-7165
US

V. Phone/Fax

Practice location:
  • Phone: 540-297-7181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: