Provider Demographics
NPI:1003349275
Name:SAVILLE, SKYLAR GRAYSON
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:GRAYSON
Last Name:SAVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9570 US HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8945
Mailing Address - Country:US
Mailing Address - Phone:251-625-8223
Mailing Address - Fax:
Practice Address - Street 1:9570 US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8945
Practice Address - Country:US
Practice Address - Phone:251-625-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.38004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program