Provider Demographics
NPI:1750331542
Name:HORNE, GAYLYN MCILWAIN (MD)
Entity Type:Individual
Prefix:
First Name:GAYLYN
Middle Name:MCILWAIN
Last Name:HORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7067 VETERANS PKWY STE 210
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-5128
Mailing Address - Country:US
Mailing Address - Phone:205-405-7348
Mailing Address - Fax:205-338-0550
Practice Address - Street 1:7067 VETERANS PARKWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125
Practice Address - Country:US
Practice Address - Phone:205-405-7348
Practice Address - Fax:205-338-0550
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.24389208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933604Medicaid
AL051532014OtherBLUE CROSS
AL009933606Medicaid
AL630649108OtherVIVA
AL9082042OtherMISSISSIPPI MEDICAID
ALP00289121OtherRAILROAD MEDICARE
AL102G708032OtherMEDICARE PTAN
AL051532013OtherBLUE CROSS
AL009933603Medicaid
AL051532011OtherBLUE CROSS