Healthcare Provider Details

I. General information

NPI: 1871352971
Provider Name (Legal Business Name): SAYLOR MCKINLEY GWINN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WELLNESS DR
SUMMERSVILLE WV
26651-5401
US

IV. Provider business mailing address

180 WELLNESS DR
SUMMERSVILLE WV
26651-5401
US

V. Phone/Fax

Practice location:
  • Phone: 304-872-0058
  • Fax: 304-872-0116
Mailing address:
  • Phone: 304-872-0058
  • Fax: 304-872-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: