Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD.38004 | AL |
NPI | 1003349275 |
---|---|
Provider Name | Skylar Grayson Saville |
First Address | Daphne, AL 36526-8945 |
Second Address | Daphne, AL 36526-8945 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2017 |
Last Update Date | 05/10/2021 |